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Caminiti G, Volterrani M, Iellamo F, Marazzi G, Manzi V, D’Antoni V, Vadalà S, Di Biasio D, Catena M, Morsella V, Perrone MA. Changes in left atrial function following two regimens of combined exercise training in patients with ischemic cardiomyopathy: a pilot study. Front Cardiovasc Med 2024; 11:1377958. [PMID: 38774661 PMCID: PMC11106494 DOI: 10.3389/fcvm.2024.1377958] [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: 01/28/2024] [Accepted: 04/05/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose Left atrial dysfunction has shown to play a prognostic role in patients with ischemic cardiomyopathy (ICM) and is becoming a therapeutic target for pharmacological and non-pharmacological interventions. The effects of exercise training on the atrial function in patients with ICM have been poorly investigated. In the present study, we assessed the effects of a 12-week combined training (CT) program on the left atrial function in patients with ICM. Methods We enlisted a total of 45 clinically stable patients and randomly assigned them to one of the following three groups: 15 to a supervised CT with low-frequency sessions (twice per week) (CTLF); 15 to a supervised CT with high-frequency sessions (thrice per week) (CTHF); and 15 to a control group following contemporary preventive exercise guidelines at home. At baseline and 12 weeks, all patients underwent a symptom-limited exercise test and echocardiography. The training included aerobic continuous exercise and resistance exercise. The analysis of variance (ANOVA) was used to compare within- and inter-group changes. Results At 12 weeks, the CTLF and CTHF groups showed a similar increase in the duration of the ergometric test compared with the control (ANOVA p < 0.001). The peak atrial longitudinal strain significantly increased in the CTHF group, while it was unchanged in the CTLF and control groups (ANOVA p = 0.003). The peak atrial contraction strain presented a significant improvement in the CTHF group compared with the CTLF and control groups. The left ventricular global longitudinal strain significantly increased in both the CTHF and the CTLF groups compared with the control group (ANOVA p = 0.017). The systolic blood pressure decreased in the CTHF and CTLF groups, while it was unchanged in the control group. There were no side effects causing the discontinuation of the training. Conclusions We demonstrated that a CT program effectively improved atrial function in patients with ICM in a dose-effect manner. This result can help with programming exercise training in this population.
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Affiliation(s)
- Giuseppe Caminiti
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, Rome, Italy
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | - Maurizio Volterrani
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, Rome, Italy
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | - Ferdinando Iellamo
- Division of Cardiology and Sports Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Vincenzo Manzi
- Department of Wellbeing, Nutrition and Sport, Pegaso Open University, Naples, Italy
| | | | - Sara Vadalà
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | | | - Matteo Catena
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | | | - Marco Alfonso Perrone
- Division of Cardiology and Sports Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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2
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Kim YJ, Park KM. Possible Mechanisms for Adverse Cardiac Events Caused by Exercise-Induced Hypertension in Long-Distance Middle-Aged Runners: A Review. J Clin Med 2024; 13:2184. [PMID: 38673457 PMCID: PMC11050973 DOI: 10.3390/jcm13082184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Sudden cardiac death (SCD) is rare among athletes. However, hypertrophic cardiomyopathy is the leading cause of SCD among those <35 years of age. Meanwhile, coronary artery disease (CAD) is the primary SCD cause among those ≥35 years of age. CAD-induced plaque ruptures are believed to be a significant cause of cardiovascular diseases in middle-aged individuals who participate in extreme long-distance running activities such as marathons. A total of 1970 articles related to EIH were identified using search terms. Out of these, 1946 studies were excluded for reasons such as arterial hypertension, exercise-induced pulmonary hypertension, the absence of exercise stress testing (EST), and a lack of relevance to EIH. The study analyzed 24 studies related to both long-distance runners with exercise-induced hypertension (EIH) and the general public. Among these, 11 studies were quasi-experimentally designed studies used in randomized controlled trials (RCTs) on long-distance runners with EIH. Additionally, 12 studies utilized cohort designs, and one study with a quasi-experimental design was conducted among the general population. Recent studies suggest that an imbalance between oxygen demand and supply due to ventricular hypertrophy may be the actual cause of cardiovascular disease, regardless of CAD. Exercising excessively over an extended period can reduce endothelial function and increase arterial stiffness, which in turn increases afterload and leads to an excessive increase in blood pressure during exercise. Exercise-induced hypertension (EIH), which increases the morbidity rate of resting hypertension and is a risk factor for cardio-cerebro-vascular diseases, is more prevalent in middle-aged long-distance runners than in runners from other age groups, and it increases the prevalence of critical arrhythmias, such as atrial fibrillation or ventricular arrhythmias. EIH is associated with angiotensin II activity, and angiotensin II receptor blockers show promising effects in middle-aged runners. Further, guidelines for preventing excessive participation in races and restricting exercise intensity and frequency would be useful. This review identifies EIH as a potential risk factor for cardiovascular diseases and describes how EIH induces SCD.
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Affiliation(s)
- Young-Joo Kim
- Department of Exercise Rehabilitation Welfare, Sungshin Women’s University, 34 da-gil, Bomun-ro, Seongbuk-gu, Seoul 02844, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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3
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Elliott AD, Ariyaratnam J, Howden EJ, La Gerche A, Sanders P. Influence of exercise training on the left atrium: implications for atrial fibrillation, heart failure, and stroke. Am J Physiol Heart Circ Physiol 2023; 325:H822-H836. [PMID: 37505470 DOI: 10.1152/ajpheart.00322.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
The left atrium (LA) plays a critical role in receiving pulmonary venous return and modulating left ventricular (LV) filling. With the onset of exercise, LA function contributes to the augmentation in stroke volume. Due to the growing focus on atrial imaging, there is now evidence that structural remodeling and dysfunction of the LA is associated with adverse outcomes including incident cardiovascular disease. In patients with established disease, pathological changes in atrial structure and function are associated with exercise intolerance, increased hospital admissions and mortality, independent of left ventricular function. Exercise training is widely recommended in patients with cardiovascular disease to improve patient outcomes and maintain functional capacity. There are widely documented changes in LV function with exercise, yet less attention has been given to the LA. In this review, we first describe LA physiology at rest and during exercise, before exploring its association with cardiac disease outcomes including atrial fibrillation, heart failure, and stroke. The adaptation of the LA to short- and longer-term exercise training is evaluated through review of longitudinal studies of exercise training in healthy participants free of cardiovascular disease and athletes. We then consider the changes in LA structure and function among patients with established disease, where adverse atrial remodeling may be implicated in the disease process. Finally, we consider important future directions for assessment of atrial structure and function using novel imaging modalities, in response to acute and chronic exercise.
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Affiliation(s)
- Adrian D Elliott
- Center for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jonathan Ariyaratnam
- Center for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Erin J Howden
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Center for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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4
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Li YS, Ao YW, Zhu DY, Zhang L, Yang RJ, Zhao YL, Zha YF. Reduced myocardial strain of interventricular septum among male amateur marathon runners: a cardiac magnetic resonance study. J Sci Med Sport 2023; 26:506-513. [PMID: 37730468 DOI: 10.1016/j.jsams.2023.06.015] [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: 01/17/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES To analyze the long-term effect of multiple marathons on cardiac structure and function in amateur marathon runners compared with healthy controls. DESIGN Cross-sectional study using male amateur marathon runners (n = 32) and age-matched cohort of male healthy controls (n = 12). METHODS A total of 32 male amateur marathon runners (age 44 ± 7 years) and 12 male healthy controls (age 42 ± 8 years) underwent cardiac magnetic resonance (CMR). The relevant parameters of cardiac structure and function were studied employing feature-tracking strain analysis. RESULTS Amateur marathon runners showed lower heart rates, body mass index and body surface area. The left ventricular (LV) mass index, LV end-diastolic volume index and right ventricular end-systolic volume index were significantly higher in amateur marathon runners compared with healthy controls. Furthermore, walls of interventricular septum (IVS) in amateur marathon runners were thicker than healthy controls. There was no significant difference between two groups in the global myocardial strain (MS) in LV. However, the segmental radial and circumferential strains of the LV were lower in amateur marathon runners compared to healthy controls, specifically in the 8th and 9th segments. Finally, we also found as the total running intensity increased, so did global longitudinal strain. CONCLUSIONS We reported higher wall thickness and lower regional radial and circumferential strain in the IVS region in amateur marathon runners, suggesting that prolonged and high-intensity exercise may cause cardiac remodeling. Further studies are needed to investigate whether this is an adaptive or maladaptive change in amateur marathon runners.
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Affiliation(s)
- Yu-Shuang Li
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Ya-Wen Ao
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Dong-Yong Zhu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Liang Zhang
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Ren-Jie Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Yi-Lin Zhao
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China.
| | - Yun-Fei Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China.
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5
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O’Riordan C, Savage E, Newell M, Flaherty G, Hartigan MSc I. Cardiovascular Disease Risk Factor Profile of Experienced Male Amateur Marathon Runners: A Systematic Review. Sports Health 2023; 15:661-672. [PMID: 37249222 PMCID: PMC10467474 DOI: 10.1177/19417381231176534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
CONTEXT Male amateur marathon runners represent a unique subset of the population who may be at increased risk of cardiovascular disease (CVD) due to their underlying risk factors and their involvement in vigorous exercise such as marathon running. OBJECTIVE To assess the modifiable risk factors (MRFs) of CVD in experienced male amateur marathon runners and health interventions on CVD risk factors. DATA SOURCES CINAHL, Cochrane Library, Embase, Medline, and SPORTDiscus. STUDY SELECTION Studies selected according to the inclusion criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION The publication dates included were from June 1, 2008 to February 29, 2020.Published primary epidemiological, observational, randomized controlled trial (RCT) and/or non-RCT studies assessing the MRFs of CVD and health interventions on CVD risk factors in male amateur marathon runners aged ≥18 years and written in the English language were included in the review. RESULTS Five studies met the inclusion criteria for analysis. These included male amateur marathon runners (n = 862), aged 42 to 77 years. Hypertension, hyperlipidemia, smoking, and alcohol use were MRFs positively associated with an increased risk of coronary atherosclerosis found in a subset of male marathon runners. No studies examined health interventions on CVD risk factors in any of the included studies. All 5 studies were of good quality from the National Heart, Lung, and Blood Institute quality assessment tools used. The risk of bias was low to moderate. CONCLUSION There is a paucity of observational studies evaluating the CVD MRFs. Negative lifestyle behaviors exist within this population despite their engagement in physical exercise through marathon running. Marathon running does not negate the long-term effects caused by past negative lifestyle behaviors. This systematic review identifies that this population may not be aware of their possible risk of atherosclerosis and, consequently, CVD.
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Affiliation(s)
- Catherine O’Riordan
- School of Nursing and Midwifery, University College Cork, Ireland
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Micheál Newell
- School of Medicine, University of Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
| | - Gerard Flaherty
- School of Medicine, University of Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
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Isath A, Koziol KJ, Martinez MW, Garber CE, Martinez MN, Emery MS, Baggish AL, Naidu SS, Lavie CJ, Arena R, Krittanawong C. Exercise and cardiovascular health: A state-of-the-art review. Prog Cardiovasc Dis 2023; 79:44-52. [PMID: 37120119 DOI: 10.1016/j.pcad.2023.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We discuss the CV adaptations to exercise, focusing on the physiological changes in the heart and vasculature. We review the impact and benefits of exercise on specific CV prevention, including type II diabetes, hypertension, hyperlipidemia, coronary artery disease, and heart failure, in addition to CVD-related and all-cause mortality. Lastly, we evaluate the current PA guidelines and various modes of exercise, assessing the current literature for the effective regimens of PA that improve CVD outcomes.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, United States of America
| | - Klaudia J Koziol
- New York Medical College, School of Medicine, Valhalla, NY, United States of America
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Sports Cardiology and Hypertrophic Cardiomyopathy, Atlantic Health, Morristown Medical Center, Morristown, NJ, United States of America
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Program in Applied Physiology, Teachers College, Columbia University, United States of America
| | - Matthew N Martinez
- Department of Pediatric Cardiology, NYU Grossman School of Medicine and Langone Medical Center, NYU Langone Health, New York, NY, United States of America
| | - Michael S Emery
- Vascular and Thoracic Institute, Section of Clinical Cardiology, Cleveland Clinic, Cleveland, OH, United States of America
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States of America
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Centre and New York Medical College, Valhalla, NY, United States of America
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States of America
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7
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Cardiac remodeling in ambitious endurance-trained amateur athletes older than 50 years–an observational study. PLoS One 2022; 17:e0266951. [PMID: 35413088 PMCID: PMC9004772 DOI: 10.1371/journal.pone.0266951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background Data on cardiac remodeling in veteran athletes are conflicting but of clinical importance. Methods Sixty-nine clinically stable and healthy individuals >50 years were identified (median 55 (IQR 52–64), 26% female). Echocardiographic features were identified in individuals, who have performed endurance sports at 70% of their maximum heart rate for at least 1 hour 3 times/ week over the previous 5 years. Results Median training time in all participants was 6 hours per week. Therefore, based on these 6 hours of weekly training, participants were grouped into 45 ambitious endurance-trained amateur athletes (EAA) and 24 recreationally active endurance-trained athletes (RAP) training ≥6 hours (6–10) and <6 hours (3.5–5), respectively. Left ventricular (LV) diameters were slightly larger in EAA than in RAP (27 mm/m2 (25–28) vs. 25 mm/m2 (24–27), p = 0.023) and EAA showed preserved diastolic function (p = 0.028) with lower E/E’ ratio (7 (6–9) vs. 9 (7–10), p = 0.039). Interventricular septal thickness and relative wall thickness ratio were similar. Global right ventricular and LV strain were similar, but left atrial (LA) reservoir strain was higher in EAA than in RAP (27% (22–34) vs. 20% (15–29), p = 0.002). Conclusions Endurance training in healthy athletes >50 years is not associated with chamber dilatation or LV hypertrophy. A weekly training duration of ≥6 hours seems beneficial to preserve diastolic function associated with an increased LA reservoir function.
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8
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The active grandparent hypothesis: Physical activity and the evolution of extended human healthspans and lifespans. Proc Natl Acad Sci U S A 2021; 118:2107621118. [PMID: 34810239 DOI: 10.1073/pnas.2107621118] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The proximate mechanisms by which physical activity (PA) slows senescence and decreases morbidity and mortality have been extensively documented. However, we lack an ultimate, evolutionary explanation for why lifelong PA, particularly during middle and older age, promotes health. As the growing worldwide epidemic of physical inactivity accelerates the prevalence of noncommunicable diseases among aging populations, integrating evolutionary and biomedical perspectives can foster new insights into how and why lifelong PA helps preserve health and extend lifespans. Building on previous life-history research, we assess the evidence that humans were selected not just to live several decades after they cease reproducing but also to be moderately physically active during those postreproductive years. We next review the longstanding hypothesis that PA promotes health by allocating energy away from potentially harmful overinvestments in fat storage and reproductive tissues and propose the novel hypothesis that PA also stimulates energy allocation toward repair and maintenance processes. We hypothesize that selection in humans for lifelong PA, including during postreproductive years to provision offspring, promoted selection for both energy allocation pathways which synergistically slow senescence and reduce vulnerability to many forms of chronic diseases. As a result, extended human healthspans and lifespans are both a cause and an effect of habitual PA, helping explain why lack of lifelong PA in humans can increase disease risk and reduce longevity.
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9
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Petek BJ, Groezinger EY, Pedlar CR, Baggish AL. Cardiac effects of detraining in athletes: A narrative review. Ann Phys Rehabil Med 2021; 65:101581. [PMID: 34624549 DOI: 10.1016/j.rehab.2021.101581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/12/2021] [Accepted: 08/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Routine physical activity stimulates numerous morphologic and functional adaptations of the cardiac system, which are commonly referred to as exercise-induced cardiac remodeling (EICR). EICR has been well documented in elite and recreational athletes, but comparatively little is known about the "reverse" cardiac adaptations during detraining in an athletic population. OBJECTIVE To assess the morphologic and functional cardiac effects of detraining in athletes. METHODS Eligible studies were identified in PubMed from inception to May 2020. Studies were included if they assessed the cardiac effects of detraining periods in athletes. RESULTS A total of 16 studies from the literature search were identified and included in this review. These studies included athletes from multiple different sporting disciplines and detraining periods ranged from 3 weeks to 13 years. Detraining periods led to significantly decreased right ventricular and left (LV) ventricular dimensions, LV mass, and LV wall thickness, but only limited changes in systolic and diastolic functional parameters were observed. CONCLUSIONS From the limited data available in this population, cardiac atrophy has been observed with short periods of detraining (1-8 weeks) but often spares systolic and diastolic heart function. Supplemental exercise training during times of rehabilitation to combat cardiac regression has not been vigorously studied in athletes, so the ideal frequency, intensity, and modality of exercise needed to maintain EICR remains unclear.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Erich Y Groezinger
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, United States
| | - Charles R Pedlar
- Faculty of Sport, Health and Applied Science, St. Mary's University, Twickenham, United Kingdom
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, United States.
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10
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Petek BJ, Baggish AL. Valvular Heart Disease in Athletes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23. [DOI: 10.1007/s11936-021-00950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Increased Expression of N2BA Titin Corresponds to More Compliant Myofibrils in Athlete's Heart. Int J Mol Sci 2021; 22:ijms222011110. [PMID: 34681770 PMCID: PMC8537917 DOI: 10.3390/ijms222011110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 12/22/2022] Open
Abstract
Long-term exercise induces physiological cardiac adaptation, a condition referred to as athlete’s heart. Exercise tolerance is known to be associated with decreased cardiac passive stiffness. Passive stiffness of the heart muscle is determined by the giant elastic protein titin. The adult cardiac muscle contains two titin isoforms: the more compliant N2BA and the stiffer N2B. Titin-based passive stiffness may be controlled by altering the expression of the different isoforms or via post-translational modifications such as phosphorylation. Currently, there is very limited knowledge about titin’s role in cardiac adaptation during long-term exercise. Our aim was to determine the N2BA/N2B ratio and post-translational phosphorylation of titin in the left ventricle and to correlate the changes with the structure and transverse stiffness of cardiac sarcomeres in a rat model of an athlete’s heart. The athlete’s heart was induced by a 12-week-long swim-based training. In the exercised myocardium the N2BA/N2B ratio was significantly increased, Ser11878 of the PEVK domain was hypophosphorlyated, and the sarcomeric transverse elastic modulus was reduced. Thus, the reduced passive stiffness in the athlete’s heart is likely caused by a shift towards the expression of the longer cardiac titin isoform and a phosphorylation-induced softening of the PEVK domain which is manifested in a mechanical rearrangement locally, within the cardiac sarcomere.
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12
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Kleinnibbelink G, Panhuyzen-Goedkoop N, Hulshof H, van Dijk A, George K, Somauroo J, Oxborough D, Thijssen DHJ. Exercise Training Induces Left- but not Right-sided Cardiac Remodelling in Olympic Rowers. Int J Sports Med 2021; 43:151-160. [PMID: 34375989 DOI: 10.1055/a-1524-2611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Whilst the athlete's heart has been extensively described, less work has focused on the potential for elite athletes to demonstrate further cardiac remodelling upon an increase in training volume. Moreover, little work explored potential side-specific cardiac remodelling. Therefore, we examined the impact of an increase in training volume across 9-months in elite rowers on left- and right-sided cardiac structure, function and mechanics (i. e. longitudinal, radial and circumferential strain, twist and strain-volume loops). As part of the preparations to the 2012 Olympic Games, twenty-seven elite rowers (26.4±3.7years, 19 male) underwent echocardiography prior to and post (9 months) an increase in training volume (24 to 30-35 h weekly). Training increased left ventricular structure, including wall thickness, diameter, volume, mass and LV twist (all p<0.05). Female rowers demonstrated larger adaptation in left ventricular diameter and mass compared to male rowers (both p<0.05). No changes were observed in other measures of left ventricular function in both sexes (all p>0.05). The 9-month intervention showed no change in right ventricular/atrial structure, function or mechanics (all p>0.05). In conclusion, our data revealed that 9-month increased training volume in elite rowers induced left-sided (but not right-sided) structural remodelling, concomitant with an increase in left ventricular twist, with some changes larger in women.
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Affiliation(s)
- Geert Kleinnibbelink
- Department of Physiology, Research Insitute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Nicole Panhuyzen-Goedkoop
- Department of Cardiology, Amsterdam University Medical Centres, AMC Amsterdam, Amsterdam, Netherlands.,Sports Cardiology, Sports Medical Centre Papendal, Arnhem, Netherlands
| | - Hugo Hulshof
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arie van Dijk
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Dick H J Thijssen
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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13
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Abstract
Heart failure affects 1-2% of the adult population and one of the main contributors to its development is cardiomyopathy. Assessing a patient's risk for adverse events in heart failure is challenging and made more difficult by the heterogenous phenotypic expression of the disease. Cardiac MRI has long been a gold standard measure of myocardial function and anatomy due to its high spatial and temporal resolution. More recently, it has been posited to play a more critical role in the diagnosis and prognosis of cardiomyopathy-related heart failure. Given the limitations of more commonly used imaging modalities, increasing the clinical use of cardiac magnetic resonance imaging could potentially improve the prognosis of specific subgroups of patients at risk of adverse cardiac events.
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Affiliation(s)
- Nishant Lahoti
- Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Richard J Jabbour
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Brian Xiangzhi Wang
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
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14
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Oviedo-Caro MA, Mayolas-Pi C, Bueno-Antequera J, Paris-García F, Murillo-Fuentes A, Reverter-Masia J, Munguía-Izquierdo D, Legaz-Arrese A. Training volume and amateur cyclists' health: a six-month follow-up from coinciding with a high-demand cycling event. Res Sports Med 2021; 29:373-385. [PMID: 33401968 DOI: 10.1080/15438627.2020.1871349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to analyse the longitudinal association of amateur cycling training volume with health by comparing the proximity of participation in a high-demand cycling event. Variations in cycling training volume, behavioural cardiometabolic risk factors, and physical and psychosocial health were examined. Cyclists decreased their training volume by approximately 40% and their total physical activity volumes by approximately 20%, while controls maintained (~5%). A time*group interaction was found for men's physical conditioning, body mass index and anxiety and, independent of gender, for behavioural cardiometabolic risk factors. Variation in cycling training volume was positively correlated with variation in physical conditioning and total physical activity and negatively correlated with variation in body mass index. The high level of cycling training volume developed at the time coinciding with a high demand cycling event predisposes to better physical health and behavioural cardiometabolic risk factors, without negatively affect psychosocial health, compared with six month later.
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Affiliation(s)
- Miguel Angel Oviedo-Caro
- Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain.,Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain
| | - Carmen Mayolas-Pi
- Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain.,Department of Physiatry and Nursery, Section of Physical Education and Sports, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | - Javier Bueno-Antequera
- Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain.,Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain
| | - Federico Paris-García
- Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain.,Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain
| | - Alfonso Murillo-Fuentes
- Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain.,Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain
| | - Joaquín Reverter-Masia
- Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain.,Section of Physical Education and Sports, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain
| | - Diego Munguía-Izquierdo
- Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain.,Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain.,Biomedical Research Networking Center on Frailty and Healthy Aging, Madrid, Spain
| | - Alejandro Legaz-Arrese
- Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain.,Department of Physiatry and Nursery, Section of Physical Education and Sports, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
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15
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Sengupta S, Jain R, Burkule N, Olet S, Khandheria BK. Myocardial Work Index: A Novel Method for Assessment of Myocardial Function in South Asian Recreational Athletes. J Patient Cent Res Rev 2020; 7:147-156. [PMID: 32377548 DOI: 10.17294/2330-0698.1730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose We used a novel noninvasive method based on speckle-tracking echocardiography to evaluate myocardial performance in South Asian recreational athletes who completed a half marathon. Methods Transthoracic echocardiography was performed on 24 recreational athletes 48 hours before they took part in a half marathon (premarathon), within 2 hours of half marathon completion (postmarathon), and 72 hours after completion. Clinical, laboratory, and echocardiographic variables were collected. Speckle-tracking echocardiography was performed in all subjects to characterize myocardial mechanics. Results Mean age of participants was 41.8 ± 7.4 years, and 23 (95.8%) were male. No subject had a prior history of coronary artery disease. Significant changes in pre- and postmarathon values suggested myocardial injury, including an increase in mean brain natriuretic peptide (BNP), an increase in left atrial volume, and an overall reduction in peak left ventricular global longitudinal strain. All subjects had a similar value of global work index, the average myocardial work, premarathon. Global work index did not change in 11 patients (Group 1), and global work index increased in 13 patients (Group 2) immediately postmarathon. Group 2 patients were noted to have higher heart rate, lower end-diastolic and end-systolic volumes, and higher BNP levels, suggesting myocardial stress. Conclusions South Asian athletes completing a half marathon exhibited two different responses to the cardiac stress of the half marathon, as outlined by the use of myocardial work indices, a novel method for assessing cardiac performance.
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Affiliation(s)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's/Aurora Sinai Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | | | - Susan Olet
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's/Aurora Sinai Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI.,Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, WI
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16
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Baggish AL, Battle RW, Beaver TA, Border WL, Douglas PS, Kramer CM, Martinez MW, Mercandetti JH, Phelan D, Singh TK, Weiner RB, Williamson E. Recommendations on the Use of Multimodality Cardiovascular Imaging in Young Adult Competitive Athletes: A Report from the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Computed Tomography and the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:523-549. [PMID: 32362332 DOI: 10.1016/j.echo.2020.02.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Robert W Battle
- University of Virginia Health System, Charlottesville, Virginia
| | | | - William L Border
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Dermot Phelan
- Sanger Heart and Vascular Institute in Atrium Health, Charlotte, North Carolina
| | | | - Rory B Weiner
- Massachusetts General Hospital, Boston, Massachusetts
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17
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D'Silva A, Bhuva AN, van Zalen J, Bastiaenen R, Abdel-Gadir A, Jones S, Nadarajan N, Menacho Medina KD, Ye Y, Augusto J, Treibel TA, Rosmini S, Ramlall M, Scully PR, Torlasco C, Willis J, Finocchiaro G, Papatheodorou E, Dhutia H, Cole D, Chis Ster I, Hughes AD, Sharma R, Manisty C, Lloyd G, Moon JC, Sharma S. Cardiovascular Remodeling Experienced by Real-World, Unsupervised, Young Novice Marathon Runners. Front Physiol 2020; 11:232. [PMID: 32256389 PMCID: PMC7093496 DOI: 10.3389/fphys.2020.00232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/28/2020] [Indexed: 12/13/2022] Open
Abstract
Aims Marathon running is a popular ambition in modern societies inclusive of non-athletes. Previous studies have highlighted concerning transient myocardial dysfunction and biomarker release immediately after the race. Whether this method of increasing physical activity is beneficial or harmful remains a matter of debate. We examine in detail the real-world cardiovascular remodeling response following competition in a first marathon. Methods Sixty-eight novice marathon runners (36 men and 32 women) aged 30 ± 3 years were investigated 6 months before and 2 weeks after the 2016 London Marathon race in a prospective observational study. Evaluation included electrocardiography, cardiopulmonary exercise testing, echocardiography, and cardiovascular magnetic resonance imaging. Results After 17 weeks unsupervised marathon training, runners revealed a symmetrical, eccentric remodeling response with 3-5% increases in left and right ventricular cavity sizes, respectively. Blood pressure (BP) fell by 4/2 mmHg (P < 0.01) with reduction in arterial stiffness, despite only 11% demonstrating a clinically meaningful improvement in peak oxygen consumption with an overall non-significant 0.4 ml/min/kg increase in peak oxygen consumption (P = 0.14). Conclusion In the absence of supervised training, exercise-induced cardiovascular remodeling in real-world novice marathon runners is more modest than previously described and occurs even without improvement in cardiorespiratory fitness. The responses are similar in men and women, who experience a beneficial BP reduction and no evidence of myocardial fibrosis or persistent edema, when achieving average finishing times.
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Affiliation(s)
- Andrew D'Silva
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Anish N Bhuva
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Jet van Zalen
- Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Rachel Bastiaenen
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amna Abdel-Gadir
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Siana Jones
- Institute for Cardiovascular Science, University College London, London, United Kingdom
| | - Niromila Nadarajan
- Institute for Cardiovascular Science, University College London, London, United Kingdom
| | - Katia D Menacho Medina
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Yang Ye
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Joao Augusto
- Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Thomas A Treibel
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Stefania Rosmini
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Manish Ramlall
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Paul R Scully
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - James Willis
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Gherardo Finocchiaro
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Efstathios Papatheodorou
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Harshil Dhutia
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Della Cole
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Irina Chis Ster
- Infection and Immunity Research Institute, St George's, University of London, London, United Kingdom
| | - Alun D Hughes
- Institute for Cardiovascular Science, University College London, London, United Kingdom
| | - Rajan Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Charlotte Manisty
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Guy Lloyd
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - James C Moon
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
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18
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Letnes JM, Nes B, Vaardal-Lunde K, Slette MB, Mølmen-Hansen HE, Aspenes ST, Støylen A, Wisløff U, Dalen H. Left Atrial Volume, Cardiorespiratory Fitness, and Diastolic Function in Healthy Individuals: The HUNT Study, Norway. J Am Heart Assoc 2020; 9:e014682. [PMID: 31986991 PMCID: PMC7033857 DOI: 10.1161/jaha.119.014682] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Left atrial (LA) size and cardiorespiratory fitness (CRF) are predictors of future cardiovascular events in high-risk populations. LA dilatation is a diagnostic criterion for left ventricular diastolic dysfunction. However, LA is dilated in endurance athletes with high CRF, but little is known about the association between CRF and LA size in healthy, free-living individuals. We hypothesized that in a healthy population, LA size was associated with CRF and leisure-time physical activity, but not with echocardiographic indexes of left ventricular diastolic dysfunction. Methods and Results In this cross-sectional study from HUNT (Nord-Trøndelag Health Study), 107 men and 138 women, aged 20 to 82 years, without hypertension, cardiovascular, pulmonary, or malignant disease participated. LA volume was assessed by echocardiography and indexed to body surface area LAVI (left atrial volume index). CRF was measured as peak oxygen uptake (VO2peak) using ergospirometry, and percent of age- and-sex-predicted VO2peak was calculated. Indexes of left ventricular diastolic dysfunction were assessed in accordance with latest recommendations. LAVI was >34 mL/m2 in 39% of participants, and LAVI was positively associated with VO2peak and percentage of age- and-sex-predicted VO2peak (β [95% CI], 0.11 [0.06-0.16] and 0.18 [0.09-0.28], respectively) and weighted minutes of physical activity per week (β [95% CI], 0.01 [0.003-0.015]). LAVI was not associated with other indexes of left ventricular diastolic dysfunction. There was an effect modification between age and VO2peak/percentage of age- and-sex-predicted VO2peak showing higher LAVI with advanced age and higher VO2peak/percentage of age- and-sex-predicted VO2peak as presented in prediction diagrams. Conclusions Interpretation of LAVI as a marker of diastolic dysfunction should be done in relation to age-relative CRF. Studies on the prognostic value of LAVI in fit subpopulations are needed.
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Affiliation(s)
- Jon Magne Letnes
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - Bjarne Nes
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | | | | | | | - Stian Thoresen Aspenes
- Department of Health Registries Norwegian Directorate of Health Oslo Norway.,Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway.,Department of Medicine Levanger Hospital Nord-Trøndelag Hospital Trust Levanger Norway
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19
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Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, D'Andrea A, D'Ascenzi F, Di Paolo FM, Edvardsen T, Gati S, Galderisi M, Heidbuchel H, Nchimi A, Nieman K, Papadakis M, Pisicchio C, Schmied C, Popescu BA, Habib G, Grobbee D, Lancellotti P. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J 2019; 39:1949-1969. [PMID: 29029207 DOI: 10.1093/eurheartj/ehx532] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/23/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Stefano Caselli
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Jeroen J Bax
- Departmentt of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fernando M Di Paolo
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Thor Edvardsen
- Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital, University of Oslo, Oslo, Norway
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Hein Heidbuchel
- Jessa Hospital, Hasselt University and Heart Center Hasselt, Hasselt, Belgium
| | | | - Koen Nieman
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Cataldo Pisicchio
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Bogdan A Popescu
- Institute of Cardiovascular Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Gilbert Habib
- Department of Cardiology, Hôpital La Timone, Marseille, France
| | - Diederick Grobbee
- Department of Epidemiology, University Medical Center, Utrecht, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, Belgium
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20
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Jiang H, Zhang B, Jia D, Yang W, Sun A, Ge J. Insights from Exercise-induced Cardioprotection-from Clinical Application to Basic Research. Curr Pharm Des 2019; 25:3751-3761. [PMID: 31593529 DOI: 10.2174/1381612825666191008102047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/06/2019] [Indexed: 01/04/2023]
Abstract
Exercise has long been recognized as a beneficial living style for cardiovascular health. It has been applied to be a central component of cardiac rehabilitation for patients with chronic heart failure (CHF), coronary heart disease (CHD), post-acute coronary syndrome (ACS) or primary percutaneous coronary intervention (PCI), post cardiac surgery or transplantation. Although the effect of exercise is multifactorial, in this review, we focus on the specific contribution of regular exercise on the heart and vascular system. We will summarize the known result of clinical findings and possible mechanisms of chronic exercise on the cardiovascular system.
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Affiliation(s)
- Hao Jiang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,NHC Key Laboratory of Viral Heart Diseases, Shanghai, China.,Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Beijian Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,NHC Key Laboratory of Viral Heart Diseases, Shanghai, China.,Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Daile Jia
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,NHC Key Laboratory of Viral Heart Diseases, Shanghai, China.,Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenlong Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,NHC Key Laboratory of Viral Heart Diseases, Shanghai, China.,Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Aijun Sun
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,NHC Key Laboratory of Viral Heart Diseases, Shanghai, China.,Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,NHC Key Laboratory of Viral Heart Diseases, Shanghai, China.,Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
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21
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Boraita A, Sánchez-Testal MV, Diaz-Gonzalez L, Heras ME, Alcocer-Ayuga M, de la Rosa A, Rabadán M, Abdul-Jalbar B, Pérez de Isla L, Santos-Lozano A, Lucia A. Apparent Ventricular Dysfunction in Elite Young Athletes: Another Form of Cardiac Adaptation of the Athlete's Heart. J Am Soc Echocardiogr 2019; 32:987-996. [DOI: 10.1016/j.echo.2019.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
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22
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Affiliation(s)
- Aaron L Baggish
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston (A.L.B.); and Institute for Exercise and Environmental Medicine, Texas Health Resources and the University of Texas Southwestern, Dallas (B.D.L.).
| | - Benjamin D Levine
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston (A.L.B.); and Institute for Exercise and Environmental Medicine, Texas Health Resources and the University of Texas Southwestern, Dallas (B.D.L.)
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23
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Acute Responses of Novel Cardiac Biomarkers to a 24-h Ultra-Marathon. J Clin Med 2019; 8:jcm8010057. [PMID: 30625976 PMCID: PMC6351937 DOI: 10.3390/jcm8010057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/31/2018] [Accepted: 01/01/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to examine the acute effect of an ultra-endurance performance on N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac specific troponin T (cTnT), creatinine kinase-myocardial band (CK-MB), high sensitive C-reactive protein (hsCRP), ischemia modified albumin (IMA), heart-type fatty acid binding protein (H-FABP) and cardiovascular function. Cardiac biomarkers were evaluated in 14 male ultra-marathoners (age 40 ± 12 years) during a 24 h ultra-marathon at five points (i.e., Pre-race; Marathon, 12-h run, 24-h run, and 48-h post-race). All subjects underwent baseline echocardiography assessment at least 10 days prior to the ultra-marathon and 48 h post-race. The average distance covered during the race was 149.4 ± 33.0 km. Running the ultra-marathon led to a progressive increase in hsCRP and H-FABP concentrations (p < 0.001). CK-MB and cTnT levels were higher after a 24-h run compared to pre-race (p < 0.05). Diastolic function was altered post-race characterized by a reduction in peak early to late diastolic filling (p < 0.01). Running an ultra-marathon significantly stimulates specific cardiac biomarkers; however, the dynamic of secretion of biomarkers linked to myocardium ischemia were differentially regulated during the ultra-marathon race. It is suggested that both exercise duration and intensity play a crucial role in cardiovascular adaptive mechanisms and cause risk of cardiac stress in ultra-marathoners.
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24
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Baggish AL. Exercise-Induced Cardiac Remodeling: Competitive Athletes Are Just the Tip of the Iceberg. Circ Cardiovasc Imaging 2018; 9:CIRCIMAGING.116.005321. [PMID: 27502062 DOI: 10.1161/circimaging.116.005321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Aaron L Baggish
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston.
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25
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Abstract
The field of sports cardiology has advanced significantly over recent times. It has incorporated clinical and research advances in cardiac imaging, electrophysiology and exercise physiology to enable better diagnostic and therapeutic management of our patients. One important endeavour has been to try and better differentiate athletic cardiac remodelling from inherited cardiomyopathies and other pathologies. Whilst our diagnostic tools have improved, there have also been errors resulting from assumptions that the pathological traits observed in the general population would be generalisable to athletic populations. However, we have learnt that athletes with hypertrophic cardiomyopathy, for example, have many unique features when compared with non-athletic patients with hypertrophic cardiomyopathy. We are learning the limitations of cross-sectional observations and a greater number of prospective studies have been initiated which should enable us to more confidently interrogate the associations between exercise, cardiac remodelling and clinical outcomes. This review of the field enables some of the world's experts in sports cardiology to reflect on where there is a need for research focus to advance knowledge and clinical care in sports cardiology.
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26
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Pedlar CR, Brown MG, Shave RE, Otto JM, Drane A, Michaud-Finch J, Contursi M, Wasfy MM, Hutter A, Picard MH, Lewis GD, Baggish AL. Cardiovascular response to prescribed detraining among recreational athletes. J Appl Physiol (1985) 2018; 124:813-820. [DOI: 10.1152/japplphysiol.00911.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Exercise-induced cardiac remodeling (EICR) and the attendant myocardial adaptations characteristic of the athlete’s heart may regress during periods of exercise reduction or abstinence. The time course and mechanisms underlying this reverse remodeling, specifically the impact of concomitant plasma volume (PV) contraction on cardiac chamber size, remain incompletely understood. We therefore studied recreational runners ( n = 21, age 34 ± 7 yr; 48% male) who completed an 18-wk training program (~7 h/wk) culminating in the 2016 Boston Marathon after which total exercise exposure was confined to <2 h/wk (no single session >1 h) for 8 wk. Cardiac structure and function, exercise capacity, and PV were assessed at peak fitness (10–14 days before) and at 4 wk and 8 wk postmarathon. Mixed linear modeling adjusting for age, sex, V̇o2peak, and marathon finish time was used to compare data across time points. Physiological detraining was evidenced by serial reductions in treadmill performance. Two distinct phases of myocardial remodeling and hematological adaptation were observed. After 4 wk of detraining, there were significant reductions in PV (Δ −6.0%, P < 0.01), left ventricular (LV) wall thickness (Δ −8.1%, <0.05), LV mass (Δ −10.3%, P < 0.001), and right atrial area (Δ −8.2%, P < 0.001). After 8 wk of detraining, there was a significant reduction in right ventricle chamber size (end-diastolic area Δ = −8.0%, P < 0.05) without further concomitant reductions in PV or LV wall thickness. Abrupt reductions in exercise training stimulus result in a structure-specific time course of reverse cardiac remodeling that occurs largely independently of PV contraction. NEW & NOTEWORTHY Significant reverse cardiac remodeling, previously documented among competitive athletes, extends to recreational runners and occurs with a distinct time course. Initial reductions in plasma volume and left ventricular (LV) mass, driven by reductions in wall thickness, are followed by contraction of the right ventricle. Consistent with data from competitive athletes, LV chamber volumes appear less responsive to detraining and may be a more permanent adaptation to sport.
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Affiliation(s)
- Charles R. Pedlar
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- School of Sport, Health and Applied Science, St Mary’s University, Twickenham, United Kingdom
| | - Marcel G. Brown
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert E. Shave
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - James M. Otto
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Aimee Drane
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Jennifer Michaud-Finch
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miranda Contursi
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meagan M. Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adolph Hutter
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael H. Picard
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory D. Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Baggish AL. Focal Fibrosis in the Endurance Athlete's Heart: Running Scarred or Running Scared? JACC Cardiovasc Imaging 2017; 11:1271-1273. [PMID: 29248664 DOI: 10.1016/j.jcmg.2017.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts.
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Zhang H, Meng J, Yu H. Trimethylamine N-oxide Supplementation Abolishes the Cardioprotective Effects of Voluntary Exercise in Mice Fed a Western Diet. Front Physiol 2017; 8:944. [PMID: 29218015 PMCID: PMC5703864 DOI: 10.3389/fphys.2017.00944] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/07/2017] [Indexed: 12/22/2022] Open
Abstract
Excessive consumption of western diet (WD) induces obesity, resulting in cardiac dysfunction. Voluntary exercise ameliorates WD-induced obesity, but its effect on cardiac dysfunction remains unclear. Recent evidence suggests that elevated trimethylamine N-oxide (TMAO), a gut microbe-derived metabolite, can impair cardiac function in WD-induced obesity. We hypothesized that cardiac dysfunction in WD-induced obesity would be prevented by voluntary exercise but abolished by TMAO supplementation. Male CD1 mice fed a WD were assigned to sedentary, exercise or exercise with TMAO treatment for 8 weeks. Male CD1 mice fed a normal diet (ND) for 8 weeks were assigned to sedentary (control). Compared with ND-sedentary mice, WD-sedentary mice gained significantly more body weight and displayed metabolic abnormalities at the end of the experiment. Echocardiography showed significantly impaired cardiac systolic and diastolic function in WD-induced obese mice. Voluntary exercise partially attenuated weight gain and metabolic disorders, but completely prevented cardiac dysfunction in WD-induced obese mice. Molecular studies revealed that WD-sedentary mice had elevated plasma TMAO levels, along with increased myocardial inflammation and fibrosis, all of which were inhibited by voluntary exercise. Of note, concomitant administration of TMAO had no effects on body weight and metabolic disorders, but it abolished the beneficial effects of voluntary exercise on cardiac dysfunction, myocardial inflammation, and fibrosis in WD-induced obese mice. The results suggest that voluntary exercise prevents cardiac dysfunction in WD-induced obesity by inhibiting myocardial inflammation and fibrosis. Moreover, the cardioprotective effects of voluntary exercise in WD-induced obesity can be abolished by TMAO supplementation, which abrogates voluntary exercise-induced changes in myocardial inflammation and fibrosis.
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Affiliation(s)
- Hongqi Zhang
- Department of Anesthesiology, Jining First People's Hospital, Jining, China
| | - Jian Meng
- Department of Anesthesiology, Jining First People's Hospital, Jining, China
| | - Haiyan Yu
- Department of Anesthesiology, Jining First People's Hospital, Jining, China
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Effects of Adolescent Sport Practice on Health Outcomes of Adult Amateur Endurance Cyclists: Adulthood Is Not Too Late to Start. J Phys Act Health 2017; 14:876-882. [DOI: 10.1123/jpah.2017-0010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: We investigated the effects of adolescent sport practice on the training, performance, and health outcomes of adult amateur endurance cyclists and compared health outcomes of 3 adult groups: amateur endurance cyclists who practiced sports during adolescence, amateur endurance cyclists who did not practice sports during adolescence, and inactive individuals. Methods: In 859 (751 men and 108 women) adult cyclists and 718 inactive subjects (307 men and 411 women), we examined adolescent sport practice, current training status, quality of life, quality of sleep, anxiety and depression, and cardiometabolic risk: body mass index, physical activity, physical fitness, adherence to Mediterranean diet, and alcohol and tobacco consumption. Results: Independent of gender, no significant differences in training, performance, or health outcomes were observed between amateur endurance cyclists who practiced sports during adolescence and those who did not. Independent of gender, cyclists reported significantly better health outcomes than inactive individuals in all variables, except depression. Conclusions: Training, performance, and health outcomes did not differ between adult amateur endurance cyclists who practiced sports during adolescence and those who did not, but their health outcomes were significantly improved compared with inactive individuals, except for depression.
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Dawes TJW, Corden B, Cotter S, de Marvao A, Walsh R, Ware JS, Cook SA, O'Regan DP. Moderate Physical Activity in Healthy Adults Is Associated With Cardiac Remodeling. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.004712. [PMID: 27502059 PMCID: PMC4991346 DOI: 10.1161/circimaging.116.004712] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/23/2016] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Cardiac mass and volumes are often elevated in athletes, but it is not known whether moderate physical activity is also associated with cardiac dilatation and hypertrophy in a healthy adult population. Methods and Results— In total, 1096 adults (54% female, median age 39 years) without cardiovascular disease or cardiomyopathy-associated genetic variants underwent cardiac magnetic resonance imaging to determine biventricular volumes and function. Physical activity was assessed using a validated activity questionnaire. The relationship between cardiac parameters and activity was assessed using multiple linear regression adjusting for age, sex, race, and systolic blood pressure. Logistic regression was performed to determine the effect of activity on the likelihood of subjects having cardiac dilatation or hypertrophy according to standard cardiac magnetic resonance normal ranges. Increasing physical activity was associated with greater left ventricular (LV) mass (β=0.23; P<0.0001) and elevated LV and right ventricular volumes (LV: β=0.26, P<0.0001; right ventricular: β=0.26, P<0.0001). Physical activity had a larger effect on cardiac parameters than systolic blood pressure (0.06≤β≤0.21) and a similar effect to age (−0.20≤β≤−0.31). Increasing physical activity was a risk factor for meeting imaging criteria for LV hypertrophy (adjusted odds ratio 2.1; P<0.0001), LV dilatation (adjusted odds ratio 2.2; P<0.0001), and right ventricular dilatation (adjusted odds ratio 2.2; P<0.0001). Conclusions— Exercise-related cardiac remodeling is not confined to athletes, and there is a risk of overdiagnosing cardiac dilatation or hypertrophy in a proportion of active, healthy adults.
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Affiliation(s)
- Timothy J W Dawes
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Ben Corden
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Sorcha Cotter
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Antonio de Marvao
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Roddy Walsh
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - James S Ware
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Stuart A Cook
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Declan P O'Regan
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.).
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Abstract
Although the lungs are a critical component of exercise performance, their response to exercise and other environmental stresses is often overlooked when evaluating pulmonary performance during high workloads. Exercise can produce capillary leakage, particularly when left atrial pressure increases related to left ventricular (LV) systolic or diastolic failure. Diastolic LV dysfunction that results in elevated left atrial pressure during exercise is particularly likely to result in pulmonary edema and capillary hemorrhage. Data from race horses, endurance athletes, and triathletes support the concept that the lungs can react to exercise and immersion stress with pulmonary edema and pulmonary hemorrhage. Immersion in water by swimmers and divers can also increase stress on pulmonary capillaries and result in pulmonary edema. Swimming-induced pulmonary edema and immersion pulmonary edema in scuba divers are well-documented events caused by the fluid shifts that occur with immersion, elevated pulmonary venous pressure during extreme exercise, and negative alveolar pressure due to inhalation resistance. Prevention strategies include avoiding extreme exercise, avoiding over hydration, and assuring that inspiratory resistance is minimized.
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Affiliation(s)
- Alfred A Bove
- Temple University School of Medicine, Philadelphia, Pennsylvania
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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.
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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
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Haslacher H, Nistler S, Batmyagmar D, Ponocny-Seliger E, Perkmann T, Scherzer TM, Kundi M, Endler G, Ratzinger F, Pilger A, Wagner OF, Winker R. Low Vitamin D Levels Do Not Predict Hyperglycemia in Elderly Endurance Athletes (but in Controls). PLoS One 2016; 11:e0157695. [PMID: 27304888 PMCID: PMC4909205 DOI: 10.1371/journal.pone.0157695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/02/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND AIM Recent studies revealed a link between hypovitaminosis D3 and the risk for hyperglycemia. Further mechanistic and interventional investigations suggested a common reason for both conditions rather than a causal relationship. Exposure to sunlight is the most relevant source of vitamin D3 (25(OH)D), whereas adipose tissue is able to store relevant amounts of the lipophilic vitamin. Since running/bicycling leads to increased out-door time and alters physiological response mechanisms, it can be hypothesized that the correlation between hypovitaminosis D3 and hyperglycemia might be disturbed in outdoor athletes. METHODS 47 elderly marathoners/bicyclists and 47 age/sex matched controls were studied in a longitudinal setting at baseline and after three years. HbA1c as a surrogate for (pre-)diabetic states was quantified via HPLC, 25(OH)D levels were measured by means of chemiluminescent assays. Physical performance was assessed by ergometry. RESULTS When adjusted for seasonal variations, 25(OH)D was significantly higher in athletes than in controls. 25(OH)D levels inversely correlated with triglycerides in both groups, whereas only in controls an association between high BMI or low physical performance with hypovitaminosis D3 had been found. Likewise, the presence of hypovitaminosis D3 at baseline successfully predicted hyperglycemia at the follow up examinations within the control group (AUC = 0.85, 95% CI [0.74, 0.96], p < .001, statistically independent from BMI), but not in athletes. CONCLUSION Our data suggest that mechanisms of HbA1c elevation might differ between athletes and controls. Thus, intense physical activity must be taken into account as a potential pre-analytic confounder when it is aimed to predict metabolic risk by vitamin D3 levels.
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Affiliation(s)
- Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Michael Kundi
- Department of Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Franz Ratzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Pilger
- Division of Occupational Medicine, Medical University of Vienna, Austria
| | - Oswald F. Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Robert Winker
- Health and Prevention Center, Sanatorium Hera, Vienna, Austria
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Abstract
There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors, including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice.
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Affiliation(s)
- Meagan M Wasfy
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Aaron L Baggish
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston.
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36
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Baggish AL. Athlete safety is a shared responsibility: insights from the RACE Paris Registry. Eur Heart J 2016; 37:2542-3. [DOI: 10.1093/eurheartj/ehv740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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37
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Eijsvogels TM, Molossi S, Lee DC, Emery MS, Thompson PD. Exercise at the Extremes. J Am Coll Cardiol 2016; 67:316-29. [DOI: 10.1016/j.jacc.2015.11.034] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/17/2015] [Accepted: 11/30/2015] [Indexed: 12/26/2022]
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Fatal water intoxication and cardiac arrest in runners during marathons: prevention and treatment based on validated clinical paradigms. Am J Med 2015; 128:1070-5. [PMID: 25910792 DOI: 10.1016/j.amjmed.2015.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 12/16/2022]
Abstract
Cerebral edema due to exercise-associated hyponatremia and cardiac arrest due to atherosclerotic heart disease cause rare marathon-related fatalities in young female and middle-aged male runners, respectively. Studies in asymptomatic middle-aged male physician-runners during races identified inflammation due to skeletal muscle injury after glycogen depletion as the shared underlying cause. Nonosmotic secretion of arginine vasopressin as a neuroendocrine stress response to rhabdomyolysis mediates hyponatremia as a variant of the syndrome of inappropriate antidiuretic hormone secretion. Fatal hyponatremic encephalopathy in young female runners was curtailed using emergent infusion of intravenous hypertonic (3%) saline to reverse cerebral edema on the basis of this paradigm. This treatment was arrived at through a consensus process within the medical community. An increasing frequency of cardiac arrest and sudden death has been identified in middle-aged male runners in 2 studies since the year 2000. Same-aged asymptomatic male physician-runners showed post-race elevations in interleukin-6 and C-reactive protein, biomarkers that predict acute cardiac events in healthy persons. Hypercoagulability with in vivo platelet activation and release of cardiac troponin and N-terminal pro-brain natriuretic peptide were also observed post-race in these same subjects. High short-term risk for atherothrombosis during races as shown by stratification of biomarkers in asymptomatic men may render nonobstructive coronary atherosclerotic plaques vulnerable to rupture. Pre-race aspirin use in this high-risk subgroup is prudent according to conclusive evidence for preventing first acute myocardial infarctions in same-aged healthy male physicians. On the basis of validated clinical paradigms, taking a low-dose aspirin before a marathon and drinking to thirst during the race may avert preventable deaths in susceptible runners.
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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.
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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
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Panza GA, Taylor BA, Zaleski AL, Thompson PD. An update on the Boston Marathon as a research laboratory. PHYSICIAN SPORTSMED 2015; 43:312-6. [PMID: 25913810 DOI: 10.1080/00913847.2015.1039923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE/METHODS The Boston Athletic Association's annual marathon, also referred to as BAA in this article, continues to be a source of subjects for exercise and endurance performance research. We performed a systematic literature review of BAA studies published in the 7 years since our prior report. RESULTS We identified 20 articles published from January 2008 to February 2015. Nine were related to cardiology; six were related to exercise physiology; four were related to metabolism; and one was related to marathon qualifying times. As in our prior, report cardiovascular studies remained the dominant topic, but with risk factors for atherosclerosis and thrombosis as the present focus. CONCLUSION Cardiac issues remain the largest subject area for BAA studies, but with more emphasis on the effect of prolonged exercise on atherosclerotic and thrombotic risk factors. This shift is associated with an increase in marathon participation by older, recreational runners at increased risk of cardiac complications due to exercise.
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Affiliation(s)
- Gregory A Panza
- a 1 Department of Cardiology, Hartford Hospital , Hartford, CT, USA
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41
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Weiner RB, Baggish AL. Cardiovascular Adaptation and Remodeling to Rigorous Athletic Training. Clin Sports Med 2015; 34:405-18. [PMID: 26100418 DOI: 10.1016/j.csm.2015.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Exercise-induced cardiac remodeling is a complex process by which the cardinal hemodynamic stresses of pressure and volume lead to a host of structural or functional adaptations. In aggregate, the constellation of changes that accompany this process serve to facilitate athletic performance by minimizing the cardiac work inherent in athletic activity. Although several key determinants of athletic cardiac adaptation have been described, observed variability across athlete cohorts remains an incompletely understood area. Ongoing and future work are required to further understand this process and ultimately to determine where the boundary lies between adaptive physiology and maladaptive disease.
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Affiliation(s)
- Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Kesherwani V, Chavali V, Hackfort BT, Tyagi SC, Mishra PK. Exercise ameliorates high fat diet induced cardiac dysfunction by increasing interleukin 10. Front Physiol 2015; 6:124. [PMID: 25954207 PMCID: PMC4406063 DOI: 10.3389/fphys.2015.00124] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 04/06/2015] [Indexed: 12/21/2022] Open
Abstract
Increasing evidence suggests that a sedentary lifestyle and a high fat diet (HFD) leads to cardiomyopathy. Moderate exercise ameliorates cardiac dysfunction, however underlying molecular mechanisms are poorly understood. Increased inflammation due to induction of pro-inflammatory cytokine such as tumor necrosis factor-alpha (TNF-α) and attenuation of anti-inflammatory cytokine such as interleukin 10 (IL-10) contributes to cardiac dysfunction in obese and diabetics. We hypothesized that exercise training ameliorates HFD- induced cardiac dysfunction by mitigating obesity and inflammation through upregulation of IL-10 and downregulation of TNF-α. To test this hypothesis, 8 week old, female C57BL/6J mice were fed with HFD and exercised (swimming 1 h/day for 5 days/week for 8 weeks). The four treatment groups: normal diet (ND), HFD, HFD + exercise (HFD + Ex) and ND + Ex were analyzed for mean body weight, blood glucose level, TNF-α, IL-10, cardiac fibrosis by Masson Trichrome, and cardiac dysfunction by echocardiography. Mean body weights were increased in HFD but comparatively less in HFD + Ex. The level of TNF-α was elevated and IL-10 was downregulated in HFD but ameliorated in HFD + Ex. Cardiac fibrosis increased in HFD and was attenuated by exercise in the HFD + Ex group. The percentage ejection fraction and fractional shortening were decreased in HFD but comparatively increased in HFD + Ex. There was no difference between ND and ND + Ex for the above parameters except an increase in IL-10 level following exercise. Based on these results, we conclude that exercise mitigates HFD- induced cardiomyopathy by decreasing obesity, inducing IL-10, and reducing TNF-α in mice.
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Affiliation(s)
- Varun Kesherwani
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center Omaha, NE, USA
| | - Vishalakshi Chavali
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center Omaha, NE, USA
| | - Bryan T Hackfort
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center Omaha, NE, USA
| | - Suresh C Tyagi
- Department of Physiology and Biophysics, University of Louisville Louisville, KY, USA
| | - Paras K Mishra
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center Omaha, NE, USA ; Department of Anesthesiology, University of Nebraska Medical Center Omaha, NE, USA
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Abstract
Left ventricular hypertrophy (LVH) poses an independent risk of increased morbidity and mortality, including atrial arrhythmias, ventricular arrhythmias, and sudden cardiac death. The most common causes of LVH are hypertension and valvular heart disease. Electrocardiography and echocardiography are the first steps in the diagnosis and evaluation of therapy in patients with LVH. Cardiac MRI is the gold standard in diagnosis and assessment of response to therapy. Management of LVH should be based on etiology, evidence, and guideline adherence. Timely and optimal management of the underlying cause of LVH results in improvement (regression) of LVH and its related complications.
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Möhlenkamp S, Halle M. Myocardial adaptation in response to marathon training: do short-term benefits translate into long-term prognosis? Circ Cardiovasc Imaging 2015; 8:e003030. [PMID: 25673648 DOI: 10.1161/circimaging.115.003030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stefan Möhlenkamp
- From the Clinic of Cardiology, Angiology and Intensive Care Medicine, Bethanien Hospital Moers, Moers, Germany (S.M.); Center of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (M.H.); DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (M.H.); and Else-Kröner-Fresenius-Zentrum, Klinikum Rechts der Isar, Munich, Germany (M.H.).
| | - Martin Halle
- From the Clinic of Cardiology, Angiology and Intensive Care Medicine, Bethanien Hospital Moers, Moers, Germany (S.M.); Center of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (M.H.); DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany (M.H.); and Else-Kröner-Fresenius-Zentrum, Klinikum Rechts der Isar, Munich, Germany (M.H.)
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