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Lund GK, Leptin S, Ragab H, Sinn MR, Fierenz A, Cavus E, Muellerleile K, Chen H, Erley J, Harms P, Kisters A, Starekova J, Adam G, Tahir E. Prognostic Relevance of Ischemic Late Gadolinium Enhancement in Apparently Healthy Endurance Athletes: A Follow-up Study Over 5 years. SPORTS MEDICINE - OPEN 2024; 10:13. [PMID: 38282168 PMCID: PMC10822825 DOI: 10.1186/s40798-024-00680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND In many cardiac diseases, myocardial scar tissue detected by late gadolinium enhancement (LGE) is a risk factor for cardiac arrhythmia and sudden cardiac death. Previous studies in athletes reported an increased risk for cardiac events in this group of ostensibly healthy subjects. However, the currently available longitudinal studies on this topic included fairly old marathon runners with a mean age of 57 ± 6 years or represent a case-control study in athletes with preexisting ventricular arrhythmia. The purpose of this prospective study was to analyze the prognostic relevance of LGE cardiac magnetic resonance (CMR) in middle-aged endurance athletes without known preexisting cardiac disorders. METHODS Three-hundred and twelve apparently healthy athletes were prospectively enrolled. Inclusion criteria were a training for a minimum of 10 h per week and regularly participation in competitions. LGE CMR was obtained at baseline in all athletes and presence of LGE was classified visually according to established criteria as ischemic LGE, major or minor non-ischemic LGE or absent LGE. Follow-up consisted of a standardized questionnaire and an additional phone call in case of incomplete data. An event was defined as fatal myocardial infarction, ventricular tachycardia, ventricular fibrillation or sudden cardiac death (SCD). RESULTS Complete follow-up was available for 293/312 athletes (94%) including 145 triathletes, 74 marathon runners and 74 cyclists after a median of 5.6 [quartiles 4,3, 6,4] years. Median age was 44 [35, 50] years at study enrollment. Spiroergometry did not reveal heart rhythm disturbances or significant ECG changes in the study population. LGE CMR revealed myocardial scar/focal fibrosis in 80 of 293 athletes (27%) including 7 athletes (2%) with ischemic subendocardial LGE of the left ventricle (LV), 16 athletes (6%) with major non-ischemic LGE of the LV and 57 athletes (19%) with minor non-ischemic LGE. During follow-up, two athletes experienced SCD. One marathon runner died during a training run and one cyclist died suddenly at rest. Both athletes had ischemic LGE of the LV. The event rate for SCD was 0.7% in the entire study population and 28% in the 7 athletes with ischemic LGE (p < 0.001 compared to athletes without LGE). CONCLUSIONS Our findings indicate that athletes with ischemic LGE due to unrecognized myocardial infarction are at increased risk for SCD. Our findings highlight the value of LGE CMR to detect occult ischemic scar in asymptomatic apparently healthy athletes, which is of importance, since current guidelines do not recommend to incorporate routine cardiac imaging in pre-participation screening. Athletes with ischemic myocardial scar should at least consider to refrain from high-level exercise as an individual decision.
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Affiliation(s)
- Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Sharon Leptin
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Haissam Ragab
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin R Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alexander Fierenz
- Institution for Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Ersin Cavus
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Hang Chen
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Phillip Harms
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Anna Kisters
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Javed W, Malhotra A, Swoboda P. Cardiac magnetic resonance assessment of athletic myocardial fibrosis; Benign bystander or malignant marker? Int J Cardiol 2024; 394:131382. [PMID: 37741350 DOI: 10.1016/j.ijcard.2023.131382] [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: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
The benefits of exercise are irrefutable with a well-established dose-dependent relationship between exercise intensity and reduction in cardiovascular disease. Differentiating the physiological adaptation to exercise, termed the "athlete's heart" from cardiomyopathies, has been advanced by the advent of more sophisticated imaging modalities such as cardiac magnetic resonance imaging (CMR). Myocardial fibrosis on CMR is a mutual finding amongst seemingly healthy endurance athletes and individuals with cardiomyopathy. As a substrate for arrhythmias, fibrosis is traditionally associated with increased cardiovascular risk. In this article, we discuss the aetiologies, distribution and potential implications of myocardial fibrosis in athletes.
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Affiliation(s)
- Wasim Javed
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Peter Swoboda
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Piccolino FC, Fruttini D, Eandi C, Nicolò M, Mariotti C, Tito S, Lupidi M. Reply to Comment on: Vigorous Physical Activity as a Risk factor for Central Serous Chorioretinopathy. Am J Ophthalmol 2022; 249:189-190. [PMID: 36587714 DOI: 10.1016/j.ajo.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Felice Cardillo Piccolino
- Fondazione per la Macula Onlus, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy
| | - Daniela Fruttini
- Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Chiara Eandi
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland Centre de l'Odéon, Paris, France; Department of Surgical Sciences, Eye Clinic, University of Torino, Torino, Italy
| | - Massimo Nicolò
- Clinica Oculistica, DiNOGMI, Università di Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Tito
- Fondazione per la Macula Onlus, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy
| | - Marco Lupidi
- Fondazione per la Macula Onlus, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy; Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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Piccolino FC, Fruttini D, Eandi C, Nicolò M, Mariotti C, Tito S, Lupidi M. Vigorous Physical Activity as a Risk Factor for Central Serous Chorioretinopathy. Am J Ophthalmol 2022; 244:30-37. [PMID: 35948087 DOI: 10.1016/j.ajo.2022.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate whether frequent vigorous physical activity (PA) is significantly associated with active central serous chorioretinopathy (CSCR) and may represent a risk factor for CSCR. DESIGN Case-control study. METHODS This was a multicenter study. The patient population comprised consecutive patients with active CSCR and a comparable control group of healthy participants. Both groups were interrogated about their PA using a shortened version of the International Physical Activity Questionnaire. The Ainsworth Compendium of Physical Activities was taken as a reference for the activities requiring vigorous effort and to quantify the energy expended, expressed in metabolic equivalent of task (MET). As a main outcome measure, a moderate/high practice of vigorous PA was opposed to an absent/low practice of vigorous PA in the 2 groups. RESULTS A total of 105 patients with CSCR and 105 healthy controls were included in the study. Moderate/high vigorous PA was observed in 63.5% of the patients with CSCR and in 26% of the controls (P = .0001). The MET values of vigorous PA were 2173.2 ± 2081.5 in the CSCR group and 1216.3 ± 524 in the control group (P = .029). The potential risk of disease associated with moderate/high vigorous PA was 5.58 (odds ratio; 95% confidence interval 3.01-10.69, P = .0001). CONCLUSIONS This study demonstrates a significant association of vigorous PA with CSCR, indicating an increased probability of disease by 5.58 times. Frequent and intense PA, with the hypertensive episodes that it entails, can break the precarious hemodynamic balance in the choroid of individuals predisposed to CSCR, thereby favoring choroidal vascular decompensation and active disease.
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Affiliation(s)
- Felice Cardillo Piccolino
- Fondazione per la Macula Onlus (F.C.P., S.T., M.L.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy.
| | - Daniela Fruttini
- Department of Medicine and Surgery (D.F.), University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Chiara Eandi
- Department of Ophthalmology (C.E.), University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland Centre de l'Odéon, Paris, France; Department of Surgical Sciences (C.E.), Eye Clinic, University of Torino, Torino, Italy
| | - Massimo Nicolò
- Clinica Oculistica (M.N.), DiNOGMI, Università di Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Cesare Mariotti
- Eye Clinic (C.M., M.L.), Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Tito
- Fondazione per la Macula Onlus (F.C.P., S.T., M.L.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy
| | - Marco Lupidi
- Fondazione per la Macula Onlus (F.C.P., S.T., M.L.), Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy; Clinica Oculistica (M.N.), DiNOGMI, Università di Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Stegmüller F, Dinter J, Ritzer B, Seth C, Stadler L, Esefeld K, Halle M. [Sports cardiology : Which sport can be recommended for heart diseases?]. Herz 2022; 47:564-574. [PMID: 36278977 PMCID: PMC9590382 DOI: 10.1007/s00059-022-05141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
Innerhalb der Kardiologie hat der Bereich der Sportkardiologie in den letzten 10 Jahren sukzessive an Bedeutung zugenommen. Dies liegt v. a. daran, dass sich das Spektrum der Fragestellungen zu körperlichem Training in der Prävention und Sekundärprävention jenseits der klassischen kardiovaskulären Rehabilitation erweitert hat. Dieses Spektrum betrifft v. a. Jugendliche und junge Erwachsene, die bei manifester kardialer Erkrankung weiterhin körperlich aktiv sein wollen und zum Teil Freizeit- und Leistungssport anstreben. Ergänzend wird der Kreis der Patient*innen mit kardialen Erkrankungen, die auch noch im höheren Alter sportliche Höchstleistungen anstreben und Beratung suchen, immer größer. In diesen Fällen geht es dann darum, auf der einen Seite ein körperliches Training als Therapiestrategie zu empfehlen, aber auf der anderen Seite auch das kardiovaskuläre System zu schützen. Empfehlungen zu körperlichem Training sollten deshalb auch individuelle Aspekte berücksichtigen. Zusätzlich wird im ambitionierten Freizeit- und Leistungssport die Empfehlung zur Freigabe von Wettkampfsport adressiert. So fragen Patient*innen nach Sport- und Trainingsempfehlungen bei kardiovaskulären Risikofaktoren wie arterieller Hypertonie, Pathologien der Koronararterien im Sinne des Fehlabgangs der Koronarien, Muskelbrücke oder koronarer Herzkrankheit, Kardiomyopathien, Myokarditis sowie Herzrhythmusstörungen und Herzklappenfehlern. In diesem Artikel werden diese Erkrankungen mit entsprechenden sportkardiologischen Spezifika diskutiert und jeweils Empfehlungen zu körperlichem Training und Wettkampfsport gegeben.
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Affiliation(s)
- Felix Stegmüller
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Jonas Dinter
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Barbara Ritzer
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Celina Seth
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Luis Stadler
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Katrin Esefeld
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Martin Halle
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Klinikum rechts der Isar, Lehrstuhl für Präventive und Rehabilitative Sportmedizin, EAPC Centre for Sports Cardiology, Technische Universität München, Georg-Brauchle-Ring 56, 80992, München, Deutschland.
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Schultz MG, La Gerche A, Sharman JE. Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing. Exerc Sport Sci Rev 2021; 50:25-30. [PMID: 34669623 DOI: 10.1249/jes.0000000000000276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We propose that for correct clinical interpretation of exaggerated exercise blood pressure (EEBP), both cardiorespiratory fitness and exercise workload must be considered. A key recommendation towards achieving the correct clinical interpretation of EEBP is that exercise BP should be measured during submaximal exercise with a fixed external workload.
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Affiliation(s)
- Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia Baker Institute, Melbourne, Australia
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Banks L, Altaha MA, Yan AT, Dorian P, Konieczny K, Deva DP, LA Gerche A, Akhavein F, Bentley RF, Connelly KA, Goodman JM. Left Ventricular Fibrosis in Middle-Age Athletes and Physically Active Adults. Med Sci Sports Exerc 2021; 52:2500-2507. [PMID: 32472930 DOI: 10.1249/mss.0000000000002411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) and T1 mapping techniques enable the quantification of focal and diffuse myocardial LGE, respectively. Studies have shown evidence of fibrosis in middle-age athletes, but not relative to physically active (PA) adults who perform recommended physical activity levels. Therefore, we examined cardiac remodeling and presence of left ventricular (LV) LGE and T1 values in both recreational middle-age endurance athletes (EA) and PA adults. METHODS Healthy EA and PA adults (45-65 yr) completed a standardized 3-T CMR protocol with ventricular volumetry, LV LGE, and T1 mapping. RESULTS Seventy-two EA and 20 PA participants (mean age, 53 ± 5 vs 56 ± 4 yr; P < 0.01; V˙O2peak = 50 ± 7 vs 37 ± 9 mL·kg·min, P < 0.0001) were examined, with CMR data available in 89/92 participants. Focal LV LGE was observed in 30% of participants (n = 27/89): 33% of EA (n = 23/69; 33%) and 20% of PA (n = 4/20; 20%). LGE was present at the right ventricular hinge point (n = 21/89; 23.5%) or identified as ischemic (n = 2/89; 2%) or nonischemic (n = 4/89; 4%). Focal LV LGE was observed similarly in both EA and PA (P = 0.25). EA had larger LV chamber sizes and T1 native values (1169 ± 35 vs 1190 ± 26, P = 0.02) compared with PA, with similar LV ejection fraction. Global extracellular volume (ECV) was similar in both EA and PA (22.6% ± 3.5% vs 21.5% ± 2.6%, P = 0.26), with no relationship between global ECV and LV mass (r = -0.16, P = 0.19). CONCLUSIONS Focal LGE at the right ventricular hinge point was detected at the same frequency in both groups, was unrelated to demographic or clinical indices, and was found without evidence of global ECV expansion in EA, suggesting a physiologic remodeling response. The long-term clinical implications of hinge-point LGE require clarification using prospective, long-term follow-up studies.
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Affiliation(s)
- Laura Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, CANADA
| | | | | | | | | | | | | | - Farhad Akhavein
- Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, CANADA
| | - Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, CANADA
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Mohammed LLM, Dhavale M, Abdelaal MK, Alam ABMN, Blazin T, Prajapati D, Mostafa JA. Exercise-Induced Hypertension in Healthy Individuals and Athletes: Is it an Alarming Sign? Cureus 2020; 12:e11988. [PMID: 33437543 PMCID: PMC7793423 DOI: 10.7759/cureus.11988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Exercise-induced hypertension (EIH) is defined as elevated blood pressure (BP) > 190mm Hg for females and > 210 mmHg for males during exercise. EIH is prevalent among athletes and healthy individuals with no cardiovascular (CV) risk factors. While previous data corroborates exercise in reducing hypertension and cardiovascular risk, the development of EIH and its attendant cardiovascular risk necessitates a review of the pathophysiological mechanisms resulting in EIH. To date, these mechanisms causing EIH are not fully understood, nor are there any established guidelines on the management of EIH. In this article, we discuss in detail the pathophysiological mechanisms, the prognostic value, clinical implications, possible treatment, and future directions in managing EIH.
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Affiliation(s)
- Linha Lina M Mohammed
- Miscellaneous, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Meera Dhavale
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohamed K Abdelaal
- Surgery/General and Visceral Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - A B M Nasibul Alam
- Miscellaneous, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tatjana Blazin
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dhruvil Prajapati
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jihan A Mostafa
- Psychiatry/Psychotherapy, California Institute of Behavorial Neurosciences & Psychology, Fairfield, USA
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D’Ascenzi F, Fiorentini C, Anselmi F, Mondillo S. Left ventricular hypertrophy in athletes: How to differentiate between hypertensive heart disease and athlete’s heart. Eur J Prev Cardiol 2020; 28:1125-1133. [PMID: 33611377 DOI: 10.1177/2047487320911850] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
Abstract
Athlete’s heart is typically accompanied by a remodelling of the cardiac chambers induced by exercise. However, although competitive athletes are commonly considered healthy, they can be affected by cardiac disorders characterised by an increase in left ventricular mass and wall thickness, such as hypertension. Unfortunately, training-induced increase in left ventricular mass, wall thickness, and atrial and ventricular dilatation observed in competitive athletes may mimic the pathological remodelling of pathological hypertrophy. As a consequence, distinguishing between athlete’s heart and hypertension can sometimes be challenging. The present review aimed to focus on the differential diagnosis between hypertensive heart disease and athlete’s heart, providing clinical information useful to distinguish between physiological and pathological remodelling.
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Affiliation(s)
- Flavio D’Ascenzi
- Department of Medical Biotechnologies, University of Siena, Italy
| | | | | | - Sergio Mondillo
- Department of Medical Biotechnologies, University of Siena, Italy
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Abstract
Cardiovascular diseases are the leading cause of death worldwide. Adherence to a healthy lifestyle lifelong is capable of significantly reducing the cardiovascular risk by up to 70% and is therefore a key component in primary prevention of cardiovascular disease. According to the European and American guidelines lifestyle interventions include not smoking, daily physical activity of ≥150 min/week at moderate intensity or 75 min/week for higher intensity physical activity, a cardioprotective nutrition (high proportion of unsaturated fatty acids, low amounts of saturated fatty acids and low salt intake), normal body weight (body mass index 20-25 kg/m2), arterial blood pressure <140/90 mm Hg (optimum <130/80 mm Hg), low-density lipoprotein (LDL)-cholesterol target values depending on the cardiovascular risk and a normal glucose metabolism in type 2 diabetes mellitus with adjustment of a HbA1c to <7%. Lifestyle measures with weight reduction and intensification of physical activity can improve the cardiometabolic risk factors. In this way reduction of the systolic and diastolic blood pressures by approximately 10-15 mm Hg, reduction of HbA1c by approximately 1 % and reduction of triglycerides by ca. 30-40 % are possible. The LDL-cholesterol and lipoprotein(a) levels cannot be easily influenced. Beyond the recommendations for a cardioprotective lifestyle, additional pharmacological therapy may have to be added depending on the cardiovascular risk profile.
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Affiliation(s)
- Verena Heinicke
- Fakultät für Medizin, Lehrstuhl für Präventive Sportmedizin und Sportkardiologie, Technische Universität München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - Martin Halle
- Fakultät für Medizin, Lehrstuhl für Präventive Sportmedizin und Sportkardiologie, Technische Universität München, Georg-Brauchle-Ring 56, 80992, München, Deutschland.
- Munich Heart Alliance, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), München, Deutschland.
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