1
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Allwood RP, Papadakis M, Androulakis E. Myocardial Fibrosis in Young and Veteran Athletes: Evidence from a Systematic Review of the Current Literature. J Clin Med 2024; 13:4536. [PMID: 39124802 PMCID: PMC11313657 DOI: 10.3390/jcm13154536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Exercise is associated with several cardiac adaptations that can enhance one's cardiac output and allow one to sustain a higher level of oxygen demand for prolonged periods. However, adverse cardiac remodelling, such as myocardial fibrosis, has been identified in athletes engaging in long-term endurance exercise. Cardiac magnetic resonance (CMR) imaging is considered the noninvasive gold standard for its detection and quantification. This review seeks to highlight factors that contribute to the development of myocardial fibrosis in athletes and provide insights into the assessment and interpretation of myocardial fibrosis in athletes. Methods: A literature search was performed using the PubMed/Medline database and Google Scholar for publications that assessed myocardial fibrosis in athletes using CMR. Results: A total of 21 studies involving 1642 endurance athletes were included in the analysis, and myocardial fibrosis was found in 378 of 1595 athletes. A higher prevalence was seen in athletes with cardiac remodelling compared to control subjects (23.7 vs. 3.3%, p < 0.001). Similarly, we found that young endurance athletes had a significantly higher prevalence than veteran athletes (27.7 vs. 19.9%, p < 0.001), while male and female athletes were similar (19.7 vs. 16.4%, p = 0.207). Major myocardial fibrosis (nonischaemic and ischaemic patterns) was predominately observed in veteran athletes, particularly in males and infrequently in young athletes. The right ventricular insertion point was the most common fibrosis location, occurring in the majority of female (96%) and young athletes (84%). Myocardial native T1 values were significantly lower in athletes at 1.5 T (p < 0.001) and 3 T (p = 0.004), although they had similar extracellular volume values to those of control groups. Conclusions: The development of myocardial fibrosis in athletes appears to be a multifactorial process, with genetics, hormones, the exercise dose, and an adverse cardiovascular risk profile playing key roles. Major myocardial fibrosis is not a benign finding and warrants a comprehensive evaluation and follow-up regarding potential cardiac disease.
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Affiliation(s)
- Richard P. Allwood
- Sports Cardiology Department, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George’s, University of London, London SW17 0RE, UK;
| | - Emmanuel Androulakis
- Cardiovascular Clinical Academic Group, St George’s, University of London, London SW17 0RE, UK;
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2
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Ramcharan T, Edwards J, O'Driscoll J, Papadakis M. The Acute Impact of Endurance Exercise on Right Ventricular Structure and Function: A Systematic Review and Meta-analysis. Card Electrophysiol Clin 2024; 16:25-34. [PMID: 38280812 DOI: 10.1016/j.ccep.2023.09.005] [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] [Indexed: 01/29/2024]
Abstract
There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the right ventricle. This systematic review and meta-analysis summarizes and critiques 26 studies, including 649 athletes, examining the acute impact of endurance exercise on the right ventricle. We also present a subanalysis contrasting ultraendurance with endurance exercise. Finally, we identify areas for future research, such as the influence of sex, ethnicity, and age.
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Affiliation(s)
- Tristan Ramcharan
- Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom; MSc Sports Cardiology, St George's, University of London, London, United Kingdom
| | - Jamie Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent CT1 1QU, United Kingdom
| | - Jamie O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent CT1 1QU, United Kingdom.
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London, United Kingdom
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3
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Coates AM, Millar PJ, Burr JF. Investigating the roles of exercise intensity and biological sex on postexercise alterations in cardiac function. J Appl Physiol (1985) 2023; 134:455-466. [PMID: 36656982 DOI: 10.1152/japplphysiol.00570.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The term exercise-induced cardiac fatigue (EICF) has typically been used to describe a transient reduction in cardiac function following prolonged-strenuous exercise. Recent evidence demonstrates that EICF can occur following only 45 min of high-intensity exercise when assessed using exercising stress echocardiography. This investigation sought to examine whether sprint intervals (SIT; 6 × 30 s Wingate tests), or 90-min moderate-cycling with sprint intervals (MIX; 90 min with 1 × 30 s Wingate test every 15 min) would cause greater EICF than 90 min (CON) or 3 h (LONG) moderate-cycling assessed using stress echocardiography, with a secondary aim to interrogate sex differences in EICF. Seventeen participants (M: 9, F: 8) underwent three cycling sessions with stress-echocardiography performed before-and-after each condition at a target heart rate (HR) of 100 beats·min-1, with the CON testing occurring at the mid-point of the 3 h LONG condition. For all conditions, measures of left ventricular (LV) systolic [stroke volume, ejection fraction (EF), peak longitudinal strain, isovolumetric contraction time, S') and diastolic (E/A, E', isovolumetric relaxation time, longitudinal strain rate) function were reduced after exercise (all P < 0.05). In the right ventricle (RV), systolic function was reduced (tricuspid annular plane systolic excursion, S', peak longitudinal strain and strain rate) following all conditions, and fractional area change was reduced to the greatest degree following SIT (condition × time, P = 0.01). Females demonstrated lesser impairments in LV EF, and elastance (ESP/ESV) compared with males (P < 0.05). Markers of EICF occurred similarly following all cycling loads, suggesting the functional changes may be due to altered loading conditions and reduced stress-echocardiography workload. However, males experienced greater cardiac alterations in some measures, likely due to greater changes in postexercise loading conditions.NEW & NOTEWORTHY This investigation sought to determine the role of exercise intensity on the magnitude of exercise-induced cardiac fatigue using stress echocardiography to maintain loading conditions, with a secondary purpose of assessing sex differences. Unexpectedly, it was found that all cycling loads elicited the same magnitude of functional alteration, which likely represents a common response to exercise and stress echocardiography, rather than intrinsic cardiac impairment. Males demonstrated greater alterations than females, likely due to sex differences in postexercise hemodynamics.
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Affiliation(s)
- Alexandra M Coates
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Philip J Millar
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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4
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Graziano F, Juhasz V, Brunetti G, Cipriani A, Szabo L, Merkely B, Corrado D, D’Ascenzi F, Vago H, Zorzi A. May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review. J Cardiovasc Dev Dis 2022; 9:jcdd9100347. [PMID: 36286299 PMCID: PMC9604467 DOI: 10.3390/jcdd9100347] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise would be beneficial compared to a sedentary lifestyle, while very high-dose physical activity would paradoxically be detrimental. We reviewed the available evidence on the potential adverse effects of very intense, prolonged exercise on the cardiovascular system, both acute and chronic, in healthy athletes without pre-existing cardiovascular conditions. We found that endurance sports activities may cause reversible electrocardiographic changes, ventricular dysfunction, and troponin elevation with complete recovery within a few days. The theory that repeated bouts of acute stress on the heart may lead to chronic myocardial damage remains to be demonstrated. However, male veteran athletes with a long sports career show an increased prevalence of cardiovascular abnormalities such as electrical conduction delay, atrial fibrillation, myocardial fibrosis, and coronary calcifications compared to non-athletes. It must be underlined that the cause-effect relationship between such abnormalities and the exercise and, most importantly, the prognostic relevance of such findings remains to be established.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Vencel Juhasz
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Liliana Szabo
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Hajnalka Vago
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-049-8212322
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5
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The Acute Impact of Endurance Exercise on Right Ventricular Structure and Function. Cardiol Clin 2022; 41:25-34. [DOI: 10.1016/j.ccl.2022.08.004] [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: 11/18/2022]
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6
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Valenzuela PL, Baggish A, Castillo-García A, Santos-Lozano A, Boraita A, Lucia A. Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations. Compr Physiol 2022; 12:4067-4085. [PMID: 35950659 DOI: 10.1002/cphy.c210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although the benefits of regular physical activity on cardiovascular health are well established, the effects of strenuous endurance exercise (SEE) have been a matter of debate since ancient times. In this article, we aim to provide a balanced overview of what is known about SEE and the heart-from epidemiological evidence to recent cardiac imaging findings. Lifelong SEE is overall cardioprotective, with endurance master athletes showing in fact a youthful heart. Yet, some lines of research remain open, such as the need to elucidate the time-course and potential relevance of transient declines in heart function (or increases in biomarkers of cardiac injury) with SEE. The underlying mechanisms and clinical relevance of SEE-associated atrial fibrillation, myocardial fibrosis, or high coronary artery calcium scores also remain to be elucidated. © 2022 American Physiological Society. Compr Physiol 12:1-19, 2022.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adrián Castillo-García
- Fissac - Physiology, Health and Physical Activity, Madrid, Spain.,Biology Systems Department, University of Alcalá, Madrid, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain
| | - Alejandro Lucia
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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7
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Lee BA, Kim YJ. Effect of regular endurance exercises on management of cardiovascular health in middle-aged men. J Exerc Rehabil 2022; 18:50-56. [PMID: 35356140 PMCID: PMC8934609 DOI: 10.12965/jer.2142674.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
This study was conducted to investigate the effect of regular endurance exercises on the management of cardiovascular health in middle-aged men. The following conclusions were drawn as the result of comparatively analyzing middle-aged men who regularly performed triathlon and cycling exercises for more than 5 years. The effect of regular endurance exercises on cardiovascular health management in middle-aged men was found to be relatively positive. However, prolonged endurance exercises can cause cardiovascular disease which can adversely affect the cardiac function, and to date, no defining limit is known about the amount of exercise that improves the cardiovascular function while reducing the cardiovascular events. Therefore, aiming for exercises at moderate intensity that befit the individual’s fitness level as well as conducting regular examinations to predict and manage the risk of sudden cardiac death from exercising were considered as the more effective method of cardiovascular health management.
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Affiliation(s)
- Bo-Ae Lee
- Department of Anti-aging Healthcare Education, College of Education, Changwon National University, Changwon,
Korea
- Department of Physical Education, College of Education, Pusan National University, Busan,
Korea
| | - Young-Joo Kim
- Department of Exercise Rehabilitation, Welfare Soojung Campus, Sungshin University, Seoul,
Korea
- Corresponding author: Young-Joo Kim, Department of Exercise Rehabilitation, Welfare Soojung Campus, Sungshin University, 2 Bomun-ro 34da-gil, Seoungbuk-gu, Seoul 02844, Korea,
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8
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Athlete’s Heart in Elite Biathlon, Nordic Cross—Country and Ski-Mountaineering Athletes: Cardiac Adaptions Determined Using Echocardiographic Data. J Cardiovasc Dev Dis 2021; 9:jcdd9010008. [PMID: 35050218 PMCID: PMC8779238 DOI: 10.3390/jcdd9010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Twelve world elite Biathlon (Bia), ten Nordic Cross Country (NCC) and ten ski-mountaineering (Ski-Mo) athletes were evaluated for pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, sports-related cardiac remodeling was analyzed by performing two-dimensional echocardiography including speckle tracking analysis as left ventricular global longitudinal strain (LV-GLS). A multicenter retrospective analysis of echocardiographic data was performed in 32 elite world winter sports athletes, which were obtained between 2020 and 2021 during the annual medical examination. The matched data of the elite world winter sports athletes (14 women, 18 male athletes, age: 18–35 years) were compared for different echocardiographic parameters. Significant differences could be revealed for left ventricular systolic function (LV-EF, p = 0.0001), left ventricular mass index (LV Mass index, p = 0.0078), left atrial remodeling by left atrial volume index (LAVI, p = 0.0052), and LV-GLS (p = 0.0003) between the three professional winter sports disciplines. This report provides new evidence that resting measures of cardiac structure and function in elite winter sport professionals can identify sport specific remodeling of the left heart, against the background of training schedule and training frequency.
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9
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Absence of cardiac damage induced by long-term intensive endurance exercise training: A cardiac magnetic resonance and exercise echocardiography analysis in masters athletes. Am J Prev Cardiol 2021; 7:100196. [PMID: 34611636 PMCID: PMC8387285 DOI: 10.1016/j.ajpc.2021.100196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 01/27/2023] Open
Abstract
Endurance long-term high level of training induces significant cardiac remodelling involving all cardiac chambers, also known as ‘athletes-heart”. Both left and right ventricular longitudinal strain increases significantly at exercise. Cardiac extracellular volume is normal in master athletes and there is no evidence of cardiac fibrosis induced by long term endurance training in master athletes. There is no evidence of cardiac damage induced by intensive endurance training in healthy asymptomatic master athletes.
Objectives It is under debate whether the long-term practice of intensive endurance exercise induces chronic cardiac damage such as myocardial fibrosis and ventricle contractile dysfunction. Multimodality analysis was performed to evaluate myocardial damage induced by long term intensive endurance training in master athletes. Methods Thirty-three asymptomatic endurance master athletes (47 ± 6 year-old, 9,6 ± 1,7 h training/week for 26 ± 6 years), were compared to 18 sedentary controls (49 ± 7 year-old). They underwent a CMR protocol including 4 chambers morphological and late gadolinium-enhancement (LGE) analysis, left (LV) and right ventricular (RV) T1 mapping and calculation of cardiac extracellular volume (ECV). A maximal exercise echocardiography with left and right ventricular longitudinal global strain (LGS) analysis was performed. Cardiac biomarkers of fibrosis (high sensitive cardiac Troponin T, N-Terminal pro brain natriuretic peptide, N-terminal propeptide of procollagen type I and N-terminal propeptide of procollagen type III) were analysed. Results Athletes had larger left and right atrial volume, LV and RV end diastolic volume and increased LV and RV mass compared to controls. LGE was not found in athletes. Native T1 values of LV and RV were not significantly different in athletes compared with controls. ECV was normal in both groups (21,5%± 1,6% [18.3 – 23%] in athletes, 22%± 2,2% [18.5 – 27%] in controls). LV and RV peak exercise LGS values were higher in athletes. Cardiac biomarkers levels were normal. Conclusion Despite significant physiological cardiac remodelling, consistent with previous descriptions of athlete's heart, there was no evidence of myocardial fibrosis or exercise left or right ventricular dysfunction or cardiac fibrosis in endurance athletes. Our results are not supporting the hypothesis of deleterious cardiac effects induced by long term and intensive endurance exercise training.
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10
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Martínez V, Sanz-de la Garza M, Domenech-Ximenos B, Fernández C, García-Alvarez A, Prat-González S, Yanguas C, Sitges M. Cardiac and Pulmonary Vascular Remodeling in Endurance Open Water Swimmers Assessed by Cardiac Magnetic Resonance: Impact of Sex and Sport Discipline. Front Cardiovasc Med 2021; 8:719113. [PMID: 34490379 PMCID: PMC8417574 DOI: 10.3389/fcvm.2021.719113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/29/2021] [Indexed: 01/02/2023] Open
Abstract
Background: The cardiac response to endurance exercise has been studied previously, and recent reports have described the extension of this remodeling to the pulmonary vasculature. However, these reports have focused primarily on land-based sports and few data are available on exercise-induced cardio-pulmonary adaptation in swimming. Nor has the impact of sex on this exercise-induced cardio-pulmonary remodeling been studied in depth. The main aim of our study was to evaluate cardiac and pulmonary circulation remodeling in endurance swimmers. Among the secondary objectives, we evaluate the impact of sex and endurance sport discipline on this cardio-pulmonary remodeling promoted by exercise training. Methods:Resting cardiovascular magnetic resonance imaging was performed in 30 healthy well-trained endurance swimmers (83.3% male) and in 19 terrestrial endurance athletes (79% male) to assess biventricular dimensions and function. Pulmonary artery dimensions and flow as well as estimates of pulmonary vascular resistance (PVR) were also evaluated. Results:In relation to the reference parameters for the non-athletic population, male endurance swimmers had larger biventricular and pulmonary artery size (7.4 ± 1.0 vs. 5.9 ± 1.1 cm2, p < 0.001) with lower biventricular ejection fraction (EF) (left ventricular (LV) EF: 58 ± 4.4 vs. 67 ± 4.5 %, p < 0.001; right ventricular (RV) EF: 60 ± 4 vs. 66 ± 6 %, p < 0.001), LV end-diastolic volume (EDV): 106 ± 11 vs. 80 ± 9 ml/m2, p < 0.001; RV EDV: 101 ± 14 vs. 83 ± 12 ml/m2, p < 0.001). Significantly larger LV volume and lower LV EF were also observed in female swimmers (LV EF: 60 ± 5.3 vs. 67 ± 4.6 %, p = 0.003; LV EDV: 90 ± 17.6 vs. 75± 8.7 ml/m2, p = 0.002). Compared to terrestrial endurance athletes, swimmers showed increased LV indexed mass (75.0 ± 12.8 vs. 61.5 ± 10.0 g/m2, p < 0.001). The two groups of endurance athletes had similar pulmonary artery remodeling. Conclusions: Cardiac response to endurance swimming training implies an adaptation of both ventricular and pulmonary vasculature, as in the case of terrestrial endurance athletes. Cardio-pulmonary remodeling seems to be less extensive in female than in male swimmers.
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Affiliation(s)
- Vanessa Martínez
- Department of Cardiology, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | - María Sanz-de la Garza
- Hospital Clínic, Cardiovascular Institute, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Blanca Domenech-Ximenos
- Hospital Clínic, Cardiovascular Institute, IDIBAPS, University of Barcelona, Barcelona, Spain.,Department of Radiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - César Fernández
- Department of Cardiology, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | - Ana García-Alvarez
- Hospital Clínic, Cardiovascular Institute, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Susanna Prat-González
- Hospital Clínic, Cardiovascular Institute, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carles Yanguas
- Department of Radiology, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Barcelona, Spain
| | - Marta Sitges
- Hospital Clínic, Cardiovascular Institute, IDIBAPS, University of Barcelona, Barcelona, Spain
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11
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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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12
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Christou GA, Deligiannis AP, Kouidi EJ. The role of cardiac computed tomography in pre-participation screening of mature athletes. Eur J Sport Sci 2021; 22:636-649. [PMID: 33517865 DOI: 10.1080/17461391.2021.1883125] [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
The overwhelming majority of sports-related sudden cardiac deaths in mature athletes is attributed to coronary artery disease (CAD). Coronary plaques of mature athletes appear to be more calcified compared to sedentary individuals and thus may be more stable and less likely to be associated with an acute coronary event. Cardiac computed tomography (CT), including unenhanced CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography, is characterized by very high negative predictive value to rule out CAD. Cardiac CT has been shown to have additional diagnostic value for detection of CAD in athletes over and above exercise electrocardiogram. Moreover, measurement of CACS possibly enables a more precise cardiovascular risk stratification of mature athletes. The main advantage of cardiac CT is its noninvasive nature. Although cardiac CT appears to increase the overall cost of cardiac examinations, this additional cost is much lower than the cost of unnecessary invasive coronary angiographies that would be performed in case of false positive results of exercise electrocardiograms. Radiation exposure may not be a major concern for the application of this modality to pre-participation screening of athletes, since recent technical advancements have resulted in low radiation dose of cardiac CT.Highlights Coronary computed tomography angiography can be used in pre-participation screening of mature athletes to increase the negative predictive value for excluding coronary artery disease.The identification of coronary artery calcium score = 0 in an athlete can improve risk stratification, since this athlete can be reasonably managed as an individual with low cardiovascular risk.
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Affiliation(s)
- Georgios A Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece.,MSc Sports Cardiology, St George's University of London, London, United Kingdom
| | - Asterios P Deligiannis
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia J Kouidi
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Zhang CD, Xu SL, Wang XY, Tao LY, Zhao W, Gao W. Prevalence of Myocardial Fibrosis in Intensive Endurance Training Athletes: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2020; 7:585692. [PMID: 33102537 PMCID: PMC7545401 DOI: 10.3389/fcvm.2020.585692] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/25/2020] [Indexed: 01/22/2023] Open
Abstract
Objective: To review the published literature reporting on the incidence of myocardial fibrosis (MF) in high-intensity endurance athletes measured by late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging (CMR). Methods: Five databases (PubMed, Cochrane Controlled Trials Register, EMBASE, Web of Science, and SPORTDiscus) were searched to obtain case cohort studies published before November 10, 2019. From 96 abstracts or reports extracted, 18 full-text articles were reviewed. The incidence of LGE was reported as outcome measures. Subgroup analysis was performed by age (under or above 50 years). Pooled estimates were obtained using a fixed-effects model. Results: After a full-text assessment, 12 studies involving 1,359 participants were included for analysis. Among them, 163/772 participants in the endurance athletes group showed LGE positive, compared with 19/587 participants in the comparison group. The results of the meta-analysis suggested that the prevalence of LGE was higher in the athletes group with long-term endurance exercise (OR 7.20;95%CI: 4.51-11.49). In addition, the same conclusion was drawn after the stratification of age. Conclusions: The available evidence demonstrates that high-intensity endurance athletes is associated with an increased incidence of LGE positive.
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Affiliation(s)
- Cheng-Duo Zhang
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Shun-Lin Xu
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Xin-Yu Wang
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Li-Yuan Tao
- Department of Epidemiology, Peking University Third Hospital, Beijing, China
| | - Wei Zhao
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Wei Gao
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
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14
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Wundersitz DWT, Gordon BA, Lavie CJ, Nadurata V, Kingsley MIC. Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis. Prog Cardiovasc Dis 2020; 63:750-761. [PMID: 32663493 DOI: 10.1016/j.pcad.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare heart structure and function in endurance athletes relative to participants of other sports and non-athletic controls in units relative to body size. A secondary objective was to assess the association between endurance cycling and cardiac abnormalities. PATIENTS AND METHODS Five electronic databases (CINAHL, Cochrane Library, Medline, Scopus, and SPORTdiscus) were searched from the earliest record to 14 December 2019 to identify studies investigating cardiovascular structure and function in cyclists. Of the 4865 unique articles identified, 70 met inclusion criteria and of these, 22 articles presented 10 cardiovascular parameters in units relative to body size for meta-analysis and five presented data relating to incidence of cardiac abnormalities. Qualitative analysis was performed on remaining data. The overall quality of evidence was assessed using GRADE. Odds ratios were calculated to compare the incidence of cardiac abnormality. RESULTS Heart structure was significantly larger in cyclists compared to non-athletic controls for left ventricular: mass; end-diastolic volume, interventricular septal diameter and internal diameter; posterior wall thickness, and end-systolic internal diameter. Compared to high static and high dynamic sports (e.g., kayaking and canoeing), low-to-moderate static and moderate-to-high dynamic sports (e.g., running and swimming) and moderate-to-high static and low-to-moderate dynamic sports (e.g., bodybuilding and wrestling), endurance cyclists end-diastolic left ventricular internal diameter was consistently larger (mean difference 1.2-3.2 mm/m2). Cardiac abnormalities were higher in cyclists compared to controls (odds ratio: 1.5, 95%CI 1.2-1.8), but the types of cardiac abnormalities in cyclists were not different to other athletes. CONCLUSION Endurance cycling is associated with a larger heart relative to body size and an increased incidence of cardiac abnormalities relative to controls.
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Affiliation(s)
- Daniel W T Wundersitz
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia.
| | - Brett A Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | - Michael I C Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia; Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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15
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Domenech-Ximenos B, Garza MSDL, Prat-González S, Sepúlveda-Martínez Á, Crispi F, Perea RJ, Garcia-Alvarez A, Sitges M. Exercise-induced cardio-pulmonary remodelling in endurance athletes: Not only the heart adapts. Eur J Prev Cardiol 2019; 27:651-659. [PMID: 31423814 DOI: 10.1177/2047487319868545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The cumulative effects of intensive endurance exercise may induce a broad spectrum of right ventricular remodelling. The mechanisms underlying these variable responses have been scarcely explored, but may involve differential pulmonary vasculature adaptation. Our aim was to evaluate right ventricular and pulmonary circulation in highly trained endurance athletes. METHODS Ninety-three highly trained endurance athletes (>12 h training/week at least during the last five years; age: 36 ± 6 years; 52.7% male) and 72 age- and gender-matched controls underwent resting cardiovascular magnetic resonance imaging to assess cardiac dimensions and function, as well as pulmonary artery dimensions and flow. Pulmonary vascular resistance (PVR) was estimated based on left ventricular ejection fraction and pulmonary artery flow mean velocity. Resting and exercise Doppler echocardiography was also performed in athletes to estimate pulmonary artery pressure. RESULTS Athletes showed larger biventricular and biatrial sizes, slightly reduced systolic biventricular function, increased pulmonary artery dimensions and reduced pulmonary artery flow velocity as compared with controls in both genders (p < 0.05), which resulted in significantly higher estimated PVR in athletes as compared with controls (2.4 ± 1.2 vs. 1.7 ± 1.1; p < 0.05). Substantially high estimated PVR values (>4.2 WU) were found in seven of the 93 (9.3%) athletes: those exhibiting an enlarged pulmonary artery (indexed area cm2/m2: 4.8 ± 0.6 vs. 3.9 ± 0.6, p < 0.05), a decreased pulmonary artery distensibility index (%: 43.0 ± 15.2 vs. 62.0 ± 17.4, p < 0.05) and a reduced right ventricular ejection fraction (%: 49.3 ± 4.5 vs. 53.6 ± 4.6, p < 0.05). CONCLUSIONS Exercise-induced remodelling involves, besides the cardiac chambers, the pulmonary circulation and is associated with an increased estimated PVR. A small subset of athletes exhibited substantial increase of estimated PVR related to pronounced pulmonary circulation remodelling and reduced right ventricular systolic function.
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Affiliation(s)
- Blanca Domenech-Ximenos
- Radiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain.,Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Susanna Prat-González
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Álvaro Sepúlveda-Martínez
- Barcelona Centre for Maternal-Foetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Spain.,Foetal Medicine Unit, Department of Obstetrics and Gynaecology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Fatima Crispi
- Barcelona Centre for Maternal-Foetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Spain
| | | | - Ana Garcia-Alvarez
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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16
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Mansour SG, Martin TG, Obeid W, Pata RW, Myrick KM, Kukova L, Jia Y, Bjornstad P, El-Khoury JM, Parikh CR. The Role of Volume Regulation and Thermoregulation in AKI during Marathon Running. Clin J Am Soc Nephrol 2019; 14:1297-1305. [PMID: 31413064 PMCID: PMC6730516 DOI: 10.2215/cjn.01400219] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/08/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Marathon runners develop transient AKI with urine sediments and injury biomarkers suggesting nephron damage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To investigate the etiology, we examined volume and thermoregulatory responses as possible mechanisms in runners' AKI using a prospective cohort of runners in the 2017 Hartford Marathon. Vitals, blood, and urine samples were collected in 23 runners 1 day premarathon and immediately and 1 day postmarathon. We measured copeptin at each time point. Continuous core body temperature, sweat sodium, and volume were assessed during the race. The primary outcome of interest was AKI, defined by AKIN criteria. RESULTS Runners ranged from 22 to 63 years old; 43% were men. Runners lost a median (range) of 2.34 (0.50-7.21) g of sodium and 2.47 (0.36-6.81) L of volume via sweat. After accounting for intake, they had a net negative sodium and volume balance at the end of the race. The majority of runners had increases in core body temperature to 38.4 (35.8-41)°C during the race from their baseline. Fifty-five percent of runners developed AKI, yet 74% had positive urine microscopy for acute tubular injury. Runners with more running experience and increased participation in prior marathons developed a rise in creatinine as compared with those with lesser experience. Sweat sodium losses were higher in runners with AKI versus non-AKI (median, 3.41 [interquartile range (IQR), 1.7-4.8] versus median, 1.4 [IQR, 0.97-2.8] g; P=0.06, respectively). Sweat volume losses were higher in runners with AKI versus non-AKI (median, 3.89 [IQR, 1.49-5.09] versus median, 1.66 [IQR, 0.72-2.84] L; P=0.03, respectively). Copeptin was significantly higher in runners with AKI versus those without (median, 79.9 [IQR, 25.2-104.4] versus median, 11.3 [IQR, 6.6-43.7]; P=0.02, respectively). Estimated temperature was not significantly different. CONCLUSIONS All runners experienced a substantial rise in copeptin and body temperature along with salt and water loss due to sweating. Sodium and volume loss via sweat as well as plasma copeptin concentrations were associated with AKI in runners. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_13_CJASNPodcast_19_09_.mp3.
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Affiliation(s)
- Sherry G Mansour
- Program of Applied Translational Research, Department of Medicine and.,Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Wassim Obeid
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rachel W Pata
- Department of Physical Therapy, Quinnipiac University, North Haven, Connecticut; and
| | - Karen M Myrick
- University of Saint Joseph, School of Interdisciplinary Health and Science, West Hartford, Connecticut
| | - Lidiya Kukova
- Program of Applied Translational Research, Department of Medicine and
| | - Yaqi Jia
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Petter Bjornstad
- Division of Endocrinology, Department of Pediatrics and.,Division of Nephrology, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Joe M El-Khoury
- Program of Applied Translational Research, Department of Medicine and
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland;
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17
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Cardiac performance after an endurance open water swimming race. Eur J Appl Physiol 2019; 119:961-970. [PMID: 30778760 DOI: 10.1007/s00421-019-04085-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/28/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Endurance exercise competitions have shown a transient negative effect on global right ventricular (RV) performance. Most published studies are based on terrestrial sports. The aim of our study was to evaluate the cardiac effects after an open water swimming race. METHODS We evaluated 33 healthy swimmers (mean age 40.9 ± 7.2) participating in a 9.5 km open water swimming race. All subjects underwent a standard transthoracic echocardiography including an evaluation of dimensions and myocardial ventricular deformation. Echocardiography was performed 24 h before and within the first hour of arrival at the finish line. Cardiac troponin I (cTn I), NT-ProBNP and leukocytes were also evaluated. RESULTS No changes in left ventricle (LV) ejection fraction or LV global longitudinal strain were observed. A significant increase in RV end-diastolic area (RVEDA) was noted after the race (RVEDA at baseline 15.12 ± 1.86; RVEDA after race 16.06 ± 2.27, p < 0.05), but no changes were seen in RV fractional area change or RV global longitudinal strain. Cardiac biomarkers and leukocytes significantly increased. No association was detected between the increase in cTn I or NT-proBNP and the RV acute dilatation or LV performance. A significant association was observed between cTn I and leukocytes (r = 0.375, p < 0.05). CONCLUSIONS An acute RV dilatation but without an impairment in RV deformation was observed after participating in an endurance swimming race. The correlation between the increase in cTn I and leukocytes, but not with ventricular performance, may support the hypothesis of an exercise-induced increase in myocardial sarcolemmal permeability due to an inflammatory response rather than myocardial injury.
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18
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Martin TG, Pata RW, Jou D, Narowska G, Myrick K, Malloy KA, Lafalce AM, Feinn R. The influence of non-modifiable and modifiable factors on cardiac biomarkers after marathon running. J Sports Med Phys Fitness 2019; 59:1771-1778. [PMID: 30722651 DOI: 10.23736/s0022-4707.19.09247-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study investigated the influence of modifiable (training) and non-modifiable factors (age and gender) on cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) levels post-marathon. METHODS Thirteen female and nine male recreational runners participated in the 2015 Hartford Marathon. A venous blood draw was taken from each subject at 24 hours pre-race, immediately post-race and 24 hours post-race. RESULTS Weekly mileage and weekly long runs were recorded for a 12-week period prior to the marathon. No association was found between age and BNP (P=0.11, P=0.50) or cTnI (P=0.69, P=0.28) for either post-race time points. No association was found between gender and cTnI for either post-race time points (P=0.09, P=0.57). However, BNP elevation, at 24 hours post-race was more pronounced in females than males (P=0.047). For cTnI levels immediately post-race, a negative association was found for average weekly mileage (P=0.006), while a positive association was found for the number of long runs exceeding 20 miles (P=0.05). No association between training and BNP were found. CONCLUSIONS These results suggest that female runners may experience greater cardiac stress than males. In addition, runners with greater weekly training mileage experienced less cardiac stress post-race, while runners who ran too many 20+ mile long runs, experienced more cardiac stress post-marathon.
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Affiliation(s)
- Thomas G Martin
- Department of Biomedical Sciences, Quinnipiac University, Hamden, CT, USA -
| | - Rachel W Pata
- Department of Physical Therapy, Quinnipiac University, Hamden, CT, USA
| | - David Jou
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Gabriela Narowska
- Department of Biomedical Sciences, Quinnipiac University, Hamden, CT, USA
| | - Karen Myrick
- School of Nursing, Quinnipiac University, Hamden, CT, USA
| | - Kelly A Malloy
- Department of Physical Therapy, Quinnipiac University, Hamden, CT, USA
| | - Amanda M Lafalce
- Department of Physical Therapy, Quinnipiac University, Hamden, CT, USA
| | - Richard Feinn
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA
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19
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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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20
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Left atrial functional response after a marathon in healthy amateur volunteers. Int J Cardiovasc Imaging 2018; 35:633-643. [PMID: 30470971 DOI: 10.1007/s10554-018-1502-2] [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] [Received: 08/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
Middle-aged marathon runners have an increased risk of developing atrial fibrillation (AF). A previous study described that repetitive marathon running was associated with left atrial (LA) dysfunction. However, whether this change is common in marathon runners and which runners are at risk of LA dysfunction remain unknown. The purpose of this study was to determine which factors could predict LA dysfunction. We prospectively examined 12 healthy amateur volunteers (9 males, 31 ± 8 years old) who participated in a full marathon. All echocardiographic measurements and speckle-tracking echocardiography were performed before and after the marathon. The endpoint was defined as reduced LA reservoir strain 1 day after the marathon (non-responder group). Seven participants were in the non-responder group. Age (35 ± 9 vs. 26 ± 2 years, p = 0.020), augmentation index (76 ± 12 vs. 55 ± 8, p = 0.002), and diastolic blood pressures (83 ± 11 vs. 70 ± 7 mmHg, p = 0.021) in the non-responder group were significantly higher compared with the responder group. In multivariate linear regression analysis, only the augmentation index was an independent predictor of reduced LA reservoir function after the marathon (β = - 0.646, p = 0.023). The augmentation index was a predictive marker for reduction in LA reservoir function after a marathon in healthy amateur volunteers.
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21
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Burgstahler C, Cipowicz H, Thomas C, Schabel C, Mangold S, Ketelsen D, Claussen CD, Niess AM, Tsiflikas I. Coronary and carotid atherosclerosis in asymptomatic male marathon runners. Scand J Med Sci Sports 2018; 28:1397-1403. [PMID: 29239051 DOI: 10.1111/sms.13035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 12/17/2022]
Abstract
The aim of the study was to evaluate the diagnostic accuracy of carotid ultrasound (CU) to predict coronary atherosclerosis in asymptomatic male marathon runners. A total of 49 male marathon runners older than 45 years (mean age 53.3 ± 7.2 years, range 45-74 years) received CU and cardiac CT angiography (CTA) including calcium scoring (CS). Results of CU and CTA were classified binary: 1. Absence of atherosclerosis and 2. Presence of atherosclerosis. The extent of atherosclerosis was not primary end point of the study. Mean PROCAM score was 2.3% (SD 2.2, range 0.44%-12.34%). One person had to be excluded from analysis (one missing CT-scan). From the remaining 48 marathon runners, 17 (35.4%) had carotid atherosclerosis and 22 (45.8%) coronary atherosclerosis. Atherosclerosis in either exam was diagnosed in 27/48 (56.3%) marathon runners. Diagnostic accuracy of CU to predict coronary atherosclerosis was: sensitivity 54.55% (95% CI 32.2-75.6), specificity 80.8% (CI 60.6-93.4), positive predictive value 70.6 (CI 44.1-89.9), negative predictive value 67.7 (CI 48.6-83.3) with a positive likelihood ratio of 2.84 (CI 1.18-6.82) and a negative likelihood ratio of 0.56 (CI 0.34-0.92). Coronary and/or carotid atherosclerosis can be detected in more than 50% of male marathon runners aged older than 45 years. The diagnostic value of carotid ultrasound to predict coronary atherosclerosis is low but higher than the accuracy of rest- or stress-ECG. As outcome studies in sportsmen are still missing, the routine evaluation of the carotid arteries by ultrasound or even cardiac CT cannot be recommended at present. Furthermore, the incidence of atherosclerosis by our method in normal population is not known.
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Affiliation(s)
- C Burgstahler
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
| | - H Cipowicz
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
| | - C Thomas
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - C Schabel
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - S Mangold
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - D Ketelsen
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - C D Claussen
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - A M Niess
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
| | - I Tsiflikas
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
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Dores H, de Araújo Gonçalves P, Cardim N, Neuparth N. Coronary artery disease in athletes: An adverse effect of intense exercise? Rev Port Cardiol 2018; 37:77-85. [PMID: 29325803 DOI: 10.1016/j.repc.2017.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 01/07/2023] Open
Abstract
Regular physical exercise is responsible for various health benefits, and is recommended for primary and secondary cardiovascular (CV) prevention. Despite these recognized benefits, various clinical events can occur in athletes, including acute myocardial infarction and sudden cardiac death (SCD); the main cause of SCD in veteran athletes is coronary artery disease (CAD). The relationship between intense exercise training and CAD is controversial, and a U-shaped association has been hypothesized. If this is the case, screening for subclinical CAD in older athletes may be justified, and various different methodologies have been proposed. However, the methodology for screening veteran athletes is not consensual, and several markers of CAD, in addition to clinical CV risk factors, could improve risk stratification in this population. In the present paper we review the published data on CAD in athletes, focusing on the relationship between the dose of exercise and CAD, as well as the implications for pre-participation screening of veteran athletes.
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Affiliation(s)
- Hélder Dores
- Hospital das Forças Armadas, Lisbon, Portugal; Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal.
| | - Pedro de Araújo Gonçalves
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal; Hospital de Santa Cruz, CHLO, Lisbon, Portugal
| | - Nuno Cardim
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Nuno Neuparth
- NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal
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Dores H, de Araújo Gonçalves P, Cardim N, Neuparth N. Coronary artery disease in athletes: An adverse effect of intense exercise? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Tahir E, Starekova J, Muellerleile K, von Stritzky A, Münch J, Avanesov M, Weinrich JM, Stehning C, Bohnen S, Radunski UK, Freiwald E, Blankenberg S, Adam G, Pressler A, Patten M, Lund GK. Myocardial Fibrosis in Competitive Triathletes Detected by Contrast-Enhanced CMR Correlates With Exercise-Induced Hypertension and Competition History. JACC Cardiovasc Imaging 2017; 11:1260-1270. [PMID: 29248656 DOI: 10.1016/j.jcmg.2017.09.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study analyzed the presence of myocardial fibrosis detected by late gadolinium-enhancement (LGE) cardiac magnetic resonance (CMR) in correlation with the performance of competitive triathletes objectified by an exercise test and individual competition history. BACKGROUND Myocardial fibrosis detected by LGE CMR has been reported to occur in 0% to 50% of asymptomatic athletes. However, the cause and mechanisms of myocardial fibrosis are unclear. METHODS Eighty-three asymptomatic triathletes undergoing >10 training h per week (43 ± 10 years of age; 65% male) and 36 sedentary controls were studied by using LGE and extracellular volume (ECV) CMR. Parameters of physical fitness were measured by spiroergometry. Triathletes reported their lifetime competition results. RESULTS LGE CMR revealed focal nonischemic myocardial fibrosis in 9 of 54 (17%) male triathletes (LGE+) but in none of the female triathletes (p < 0.05). LGE+ triathletes had higher peak exercise systolic blood pressure (213 ± 24 mm Hg) than LGE- triathletes (194 ± 26 mm Hg; p < 0.05). Furthermore, left ventricular mass index was higher in LGE+ triathletes (93 ± 7 g/m2) than in LGE- triathletes (84 ± 11 g/m2; p < 0.05). ECV in LGE- myocardium was higher in LGE+ triathletes (26.3 ± 1.8%) than in LGE- triathletes (24.4 ± 2.2%; p < 0.05). LGE+ triathletes completed longer cumulative distances in swimming and cycling races and participated more often in middle and Iron Man distances than LGE- triathletes. A cycling race distance of >1,880 km completed during competition had the highest accuracy to predict LGE, with an area under the curve value of 0.876 (p < 0.0001), resulting in high sensitivity (89%) and specificity (79%). Multivariate analysis identified peak exercise systolic blood pressure (p < 0.05) and the swimming race distance (p < 0.01) as independent predictors of LGE presence. CONCLUSIONS Myocardial fibrosis in asymptomatic triathletes seems to be associated with exercise-induced hypertension and the race distances. There appears to be a safe upper limit, beyond which exercise may result in myocardial fibrosis.
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Affiliation(s)
- Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Alexandra von Stritzky
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Julia Münch
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Julius M Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | - Sebastian Bohnen
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Ulf K Radunski
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Eric Freiwald
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Axel Pressler
- Department of Prevention, Rehabilitation, and Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany.
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Churchill TW, Baggish AL. The Right Heart: Acute and Chronic Issues. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:83. [DOI: 10.1007/s11936-017-0581-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Braber TL, Reitsma JB, Mosterd A, Willemink MJ, Prakken NHJ, Halle M, Sharma S, Velthuis BK. Cardiac imaging to detect coronary artery disease in athletes aged 35 years and older. A scoping review. Scand J Med Sci Sports 2017; 28:1036-1047. [DOI: 10.1111/sms.12974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Affiliation(s)
- T. L. Braber
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Cardiology; Meander Medical Center; Amersfoort The Netherlands
| | - J. B. Reitsma
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. Mosterd
- Department of Cardiology; Meander Medical Center; Amersfoort The Netherlands
| | - M. J. Willemink
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - N. H. J. Prakken
- Department of Radiology; University Medical Center Groningen; Groningen The Netherlands
| | - M. Halle
- German Heart Center; Technical University Hospital; Munich Germany
| | - S. Sharma
- Department of Cardiovascular Sciences; St George's University of London; London UK
| | - B. K. Velthuis
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
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D'Ascenzi F, Pelliccia A, Solari M, Piu P, Loiacono F, Anselmi F, Caselli S, Focardi M, Bonifazi M, Mondillo S. Normative Reference Values of Right Heart in Competitive Athletes: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2017; 30:845-858.e2. [DOI: 10.1016/j.echo.2017.06.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 01/23/2023]
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Herm J, Töpper A, Wutzler A, Kunze C, Krüll M, Brechtel L, Lock J, Fiebach JB, Heuschmann PU, Haverkamp W, Endres M, Jungehulsing GJ, Haeusler KG. Frequency of exercise-induced ST-T-segment deviations and cardiac arrhythmias in recreational endurance athletes during a marathon race: results of the prospective observational Berlin Beat of Running study. BMJ Open 2017; 7:e015798. [PMID: 28775185 PMCID: PMC5629744 DOI: 10.1136/bmjopen-2016-015798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES While regular physical exercise has many health benefits, strenuous physical exercise may have a negative impact on cardiac function. The 'Berlin Beat of Running' study focused on feasibility and diagnostic value of continuous ECG monitoring in recreational endurance athletes during a marathon race. We hypothesised that cardiac arrhythmias and especially atrial fibrillation are frequently found in a cohort of recreational endurance athletes. The main secondary hypothesis was that pathological laboratory findings in these athletes are (in part) associated with cardiac arrhythmias. DESIGN Prospective observational cohort study including healthy volunteers. SETTING AND PARTICIPANTS One hundred and nine experienced marathon runners wore a portable ECG recorder during a marathon race in Berlin, Germany. Athletes underwent blood tests 2-3 days prior, directly after and 1-2 days after the race. RESULTS Overall, 108 athletes (median 48 years (IQR 45-53), 24% women) completed the marathon in 249±43 min. Blinded ECG analysis revealed abnormal findings during the marathon in 18 (16.8%) athletes. Ten (9.3%) athletes had at least one episode of non-sustained ventricular tachycardia, one of whom had atrial fibrillation; eight (7.5%) individuals showed transient ST-T-segment deviations. Abnormal ECG findings were associated with advanced age (OR 1.11 per year, 95% CI 1.01 to 1.23), while sex and cardiovascular risk profile had no impact. Directly after the race, high-sensitive troponin T was elevated in 18 (16.7%) athletes and associated with ST-T-segment deviation (OR 9.9, 95% CI 1.9 to 51.5), while age, sex and cardiovascular risk profile had no impact. CONCLUSIONS ECG monitoring during a marathon is feasible. Abnormal ECG findings were present in every sixth athlete. Exercise-induced transient ST-T-segment deviations were associated with elevated high-sensitive troponin T (hsTnT) values. TRIAL REGISTRATION ClinicalTrials.gov NCT01428778; Results.
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Affiliation(s)
- Juliane Herm
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Agnieszka Töpper
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Wutzler
- Department of Cardiology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Matthias Krüll
- SMS Medical Institute Berlin GmbH, Berlin, Germany
- SCC EVENTS GmbH, Berlin, Germany
- Berlin Academy of Sports Medicine, Berlin, Germany
| | - Lars Brechtel
- SMS Medical Institute Berlin GmbH, Berlin, Germany
- SCC EVENTS GmbH, Berlin, Germany
- Berlin Academy of Sports Medicine, Berlin, Germany
| | - Jürgen Lock
- SMS Medical Institute Berlin GmbH, Berlin, Germany
- SCC EVENTS GmbH, Berlin, Germany
- Berlin Academy of Sports Medicine, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Gerhard Jan Jungehulsing
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Berlin, Germany
- Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Karl Georg Haeusler
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Berlin, Germany
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van de Schoor FR, Aengevaeren VL, Hopman MTE, Oxborough DL, George KP, Thompson PD, Eijsvogels TMH. Myocardial Fibrosis in Athletes. Mayo Clin Proc 2016; 91:1617-1631. [PMID: 27720455 DOI: 10.1016/j.mayocp.2016.07.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/15/2016] [Accepted: 07/15/2016] [Indexed: 12/17/2022]
Abstract
Myocardial fibrosis (MF) is a common phenomenon in the late stages of diverse cardiac diseases and is a predictive factor for sudden cardiac death. Myocardial fibrosis detected by magnetic resonance imaging has also been reported in athletes. Regular exercise improves cardiovascular health, but there may be a limit of benefit in the exercise dose-response relationship. Intense exercise training could induce pathologic cardiac remodeling, ultimately leading to MF, but the clinical implications of MF in athletes are unknown. For this comprehensive review, we performed a systematic search of the PubMed and MEDLINE databases up to June 2016. Key Medical Subject Headings terms and keywords pertaining to MF and exercise (training) were included. Articles were included if they represented primary MF data in athletes. We identified 65 athletes with MF from 19 case studies/series and 14 athletic population studies. Myocardial fibrosis in athletes was predominantly identified in the intraventricular septum and where the right ventricle joins the septum. Although the underlying mechanisms are unknown, we summarize the evidence for genetic predisposition, silent myocarditis, pulmonary artery pressure overload, and prolonged exercise-induced repetitive micro-injury as contributors to the development of MF in athletes. We also discuss the clinical implications and potential treatment strategies of MF in athletes.
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Affiliation(s)
- Freek R van de Schoor
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent L Aengevaeren
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Thijs M H Eijsvogels
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Division of Cardiology, Hartford Hospital, Hartford, CT.
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Niemelä M, Kangastupa P, Niemelä O, Bloigu R, Juvonen T. Individual responses in biomarkers of health after marathon and half-marathon running: is age a factor in troponin changes? Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:575-580. [DOI: 10.1080/00365513.2016.1225122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Markus Niemelä
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
| | - Päivikki Kangastupa
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, and University of Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, and University of Tampere, Finland
| | - Risto Bloigu
- Medical Informatics and Statistics Research Group, University of Oulu, Finland
| | - Tatu Juvonen
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
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Braber TL, Mosterd A, Prakken NH, Rienks R, Nathoe HM, Mali WP, Doevendans PA, Backx FJ, Bots ML, Grobbee DE, Velthuis BK. Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete's Risk of Cardiovascular Events (MARC) study. Eur J Prev Cardiol 2016; 23:1677-84. [PMID: 27222386 DOI: 10.1177/2047487316651825] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/06/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Most exercise-related cardiac arrests in men aged ≥45 years are due to coronary artery disease (CAD). The current sports medical evaluation (SME) of middle-aged sportsmen includes medical history, physical examination and resting and exercise electrocardiography (ECG). We investigated the added value of low-dose cardiac computed tomography (CCT) - both non-contrast CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography (CCTA) - in order to detect occult CAD in asymptomatic recreational sportsmen aged ≥45 years without known cardiovascular disease. METHODS Following a normal SME (with resting and bicycle exercise ECG), 318 asymptomatic sportsmen underwent CCT and 300 (94%) had a low European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE) risk. Occult CAD was defined as a CACS ≥100 Agatston units (AU) or obstructive (≥50%) luminal stenosis on CCTA. The number needed to screen (NNS) in order to prevent one cardiovascular event within 5 years with statin treatment was estimated. RESULTS Fifty-two (16.4%, 95% confidence interval (CI): 12.7-20.8%) of 318 participants had a CACS ≥100 AU. The CCTA identified an additional eight participants with luminal narrowing ≥50% (and a CACS <100 AU). Taken together, CCT identified CAD in 60 (18.9%, 95% CI: 14.9-23.5%) of 318 participants. The 5-year estimated NNS was 183 (95% CI: 144-236) for CACS and 159 (95% CI: 128-201) for CACS combined with CCTA. CONCLUSIONS Coronary CT detects occult CAD in almost one in five asymptomatic sportsmen aged ≥45 years after a normal SME that included resting and bicycle exercise ECG. CACS reveals most of the relevant CAD with limited additional value of contrast-enhanced CCTA. The NNS in order to prevent one cardiovascular event compares favourably to that of other screening tests.
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Affiliation(s)
- Thijs L Braber
- Department of Radiology, University Medical Center Utrecht, The Netherlands Department of Cardiology, University Medical Center Utrecht, The Netherlands Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Niek H Prakken
- Department of Radiology, University Medical Center Groningen, The Netherlands
| | - Rienk Rienks
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Willem P Mali
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Frank J Backx
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Right and Left Ventricular Function and Mass in Male Elite Master Athletes. Circulation 2016; 133:1927-35. [DOI: 10.1161/circulationaha.115.020975] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
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D'Andrea A, La Gerche A, Golia E, Padalino R, Calabrò R, Russo MG, Bossone E. Physiologic and pathophysiologic changes in the right heart in highly trained athletes. Herz 2016; 40:369-78. [PMID: 25822292 DOI: 10.1007/s00059-015-4220-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Exercise causes changes in the heart in response to the hemodynamic demands of increased systemic and pulmonary requirements during exercise. Understanding these adaptations is of great importance, since they may overlap with those caused by pathological conditions. Initial descriptions of athlete's heart focused mainly on chronic adaptation of the left heart to training. In recent years, the substantial structural and functional adaptations of the right heart have been documented, highlighting the complex interplay with left heart. Moreover, there is evolving evidence of acute and chronic cardiac damage, mainly involving the right heart, which may predispose subjects to atrial and ventricular arrhythmias, configuring an exercise-induced cardiomyopathy. The aim of this article is to review the current knowledge on the physiologic and pathophysiologic changes in the right heart in highly trained athletes.
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Affiliation(s)
- A D'Andrea
- Second University of Naples, Monaldi Hospital, Via M. Schipa 44, 80122, Naples, Italy,
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Eijsvogels TMH, Fernandez AB, Thompson PD. Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise? Physiol Rev 2016; 96:99-125. [PMID: 26607287 PMCID: PMC4698394 DOI: 10.1152/physrev.00029.2014] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multiple epidemiological studies document that habitual physical activity reduces the risk of atherosclerotic cardiovascular disease (ASCVD), and most demonstrate progressively lower rates of ASCVD with progressively more physical activity. Few studies have included individuals performing high-intensity, lifelong endurance exercise, however, and recent reports suggest that prodigious amounts of exercise may increase markers for, and even the incidence of, cardiovascular disease. This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including "myocardial" creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.
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Affiliation(s)
- Thijs M H Eijsvogels
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonio B Fernandez
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul D Thompson
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Sedaghat-Hamedani F, Kayvanpour E, Frankenstein L, Mereles D, Amr A, Buss S, Keller A, Giannitsis E, Jensen K, Katus HA, Meder B. Biomarker Changes after Strenuous Exercise Can Mimic Pulmonary Embolism and Cardiac Injury—A Metaanalysis of 45 Studies. Clin Chem 2015; 61:1246-55. [DOI: 10.1373/clinchem.2015.240796] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/18/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Biomarkers are well established for diagnosis of myocardial infarction [cardiac troponins, high-sensitivity cardiac troponins (hs-cTn)], exclusion of acute and chronic heart failure [B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP)] and venous thromboembolism (d-dimers). Several studies have demonstrated acute increases in cardiac biomarkers and altered cardiac function after strenuous sports that can pretend a cardiovascular emergency and interfere with state-of-the-art clinical assessment.
METHODS
We performed a systematic review and metaanalysis of biomarker and cardiovascular imaging changes after endurance exercise. We searched for observational studies published in the English language from 1997 to 2014 that assessed these biomarkers or cardiac function and morphology directly after endurance exercise. Of 1787 identified abstracts, 45 studies were included.
RESULTS
Across all studies cardiac troponin T (cTnT) exceeded the cutoff value (0.01 ng/mL) in 51% (95% CI, 37%–64%) of participants. The measured pooled changes from baseline for high-sensitivity cTnT (hs-cTnT) were +26 ng/L (95% CI, 5.2–46.0), for cTnI +40 ng/L (95% CI, 21.4; 58.0), for BNP +10 ng/L (95% CI, 4.3; 16.6), for NT-proBNP +67 ng/L (95% CI, 49.9; 84.7), and for d-dimer +262 ng/mL (95% CI, 165.9; 358.7). Right ventricular end diastolic diameter increased and right ventricular ejection fraction as well as the ratio of the early to late transmitral flow velocities decreased after exercise, while no significant changes were observed in left ventricular ejection fraction.
CONCLUSIONS
Current cardiovascular biomarkers (cTnT, hs-cTnT, BNP, NT-proBNP, and d-dimer) that are used in clinical diagnosis of pulmonary embolism, acute coronary syndrome, and heart failure are prone to alterations due to strenuous exercise. Hence, it is necessary to take previous physical exercise into account when a cardiac emergency is suspected.
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Affiliation(s)
- Farbod Sedaghat-Hamedani
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Elham Kayvanpour
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Lutz Frankenstein
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Derliz Mereles
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Ali Amr
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Sebastian Buss
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | | | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Benjamin Meder
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
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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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Scharf M, Schmid A, Kemmler W, von Stengel S, May MS, Wuest W, Achenbach S, Uder M, Lell MM. Myocardial adaptation to high-intensity (interval) training in previously untrained men with a longitudinal cardiovascular magnetic resonance imaging study (Running Study and Heart Trial). Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002566. [PMID: 25873721 DOI: 10.1161/circimaging.114.002566] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To prospectively evaluate whether short-term high-intensity (interval) training (HI(I)T) induces detectable morphological cardiac changes in previously untrained men in cardiovascular magnetic resonance imaging. METHODS AND RESULTS Eighty-four untrained volunteers were randomly assigned to a HI(I)T group (n=42; 44.1±4.7 years) or an inactive control group (n=42; 42.3±5.6 years). HI(I)T focused on interval runs (intensity: 95%-105% of individually calculated heart rate at the anaerobic threshold). Before and after 16 weeks, all subjects underwent physiological examination, stepwise treadmill test with blood lactate analysis, and contrast-enhanced cardiovascular magnetic resonance imaging (cine, tagging, and delayed enhancement). Indexed left ventricular (LV) and right ventricular (RV) volume (LV, 77.1±8.5-83.9±8.6; RV, 80.5±8.5-86.6±8.1) and mass (LV, 58.2±6.4-63.4±8.1; RV, 14.8±1.7-16.1±2.1) significantly increased with HI(I)T. Changes in LV and RV morphological parameters with HI(I)T were highly correlated with an increase in maximal aerobic capacity (VO2max) and a decrease in blood lactate concentration at the anaerobic threshold. Mean LV and RV remodeling index of HI(I)T group did not alter with training (0.76 ±0.09 and 0.24±0.10 g/mL, respectively [P=0.97 and P=0.72]), indicating balanced cardiac adaptation. Myocardial circumferential strain decreased after HI(I)T within all 6 basal segments (anteroseptal, P=0.01 and anterolateral, P<0.001). There was no late gadolinium enhancement in any of the participants before or post HI(I)T. CONCLUSIONS Sixteen weeks of HI(I)T lead to measurable changes in cardiac atrial and ventricular morphology and function in previously untrained men. This correlates with improvements in parameters of endurance capacity. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01406730.
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Affiliation(s)
- Michael Scharf
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Axel Schmid
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Kemmler
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Simon von Stengel
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias S May
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Wuest
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan Achenbach
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael M Lell
- From the Departments of Radiology (M.S., A.S., M.S.M., W.W., M.U., M.M.L.), Medical Physics (W.K., S.v.S.), and Cardiology (S.A.), Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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Sierra AP, Ghorayeb N, Dioguardi GS, Sierra CA, Kiss MAPDM. Alteração de biomarcadores de lesão miocárdica em atletas após a Maratona Internacional de São Paulo. REV BRAS MED ESPORTE 2015. [DOI: 10.1590/1517-86922015210302223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Apesar de a prática regular de exercício físico reduzir o risco de doença cardiovascular, estudos recentes têm documentado elevações em biomarcadores relacionados com danos cardíacos após exercícios prolongados em indivíduos aparentemente saudáveis. OBJETIVO: Investigar as alterações nos níveis de brain natriuretic peptide (BNP) e troponina T cardíaca (cTnT) em atletas amadores após uma maratona, assim como verificar as possíveis relações entre as alterações, antes e depois da prova, apresentada pelos dois biomarcadores e variáveis do teste cardiopulmonar. MÉTODOS: Estudamos 38 atletas do sexo masculino (40,9 ± 6,29 anos) antes e depois da Maratona Internacional de São Paulo, SP, Brasil. Foram realizadas coletas de sangue na veia antecubital para mensurar os biomarcadores cardíacos, cTnT e BNP 24h antes, imediatamente após e 24h após a maratona. Foi realizado teste cardiopulmonar máximo nas três semanas que antecederam a prova. RESULTADOS: Os valores de BNP e cTnT aumentaram imediatamente após a maratona (p<0,001) quando comparados com os valores basais. No terceiro momento (24h) os valores de troponina tiveram uma redução significativa caracterizando um retorno aos valores basais. Não encontramos correlação entre idade e variáveis referentes a intensidade da maratona, porém encontramos correlação dos biomarcadores com o tempo de conclusão da maratona. CONCLUSÃO: Diferentes causas de liberação podem ser assumidas para cTnT e BNP e, neste caso, parecem não refletir dano miocárdico devido ao comportamento da curva destes marcadores, além de não haver relação entre a liberação dos dois biomarcadores.
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Affiliation(s)
- Ana Paula Sierra
- Universidade de São Paulo, Brasil; Universidade Nove de Julho, Brasil; Instituto Dante Pazzanese de Cardiologia, Brasil
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Addison O, Steinbrenner G, Goldberg AP, Katzel LI. Aging, Fitness, and Marathon Times in a 91 Year-old Man Who Competed in 627 Marathons. ACTA ACUST UNITED AC 2015; 8:1074-1079. [PMID: 26290832 PMCID: PMC4538980 DOI: 10.9734/bjmmr/2015/17946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aging is associated with a decline in maximal aerobic capacity (VO2max) that may be attenuated by chronic endurance exercise. This case study chronicles the changes in marathon times in a 91 year old man who completed 627 marathons and 117 ultramarathons over 42 years. He began running marathons at age 48. His yearly best times remained fairly constant at ~240 minutes from age 50 – 64 years and then gradually rose to about 260 minutes in his early seventies followed by a curvilinear deterioration as he approached his ninth decade. His times plateaued at ~ 600 minutes in his late eighties. Between ages 68 and 89 his VO2max declined from 43 to 20 ml/kg/min. His marathon times were highly correlated with his VO2max (r2=0.87). The decline in marathons times and VO2max may reflect the contributions of biological aging, changes in exercise training volume and intensity, injuries, and comorbid disease.
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Affiliation(s)
- Odessa Addison
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, USA. ; The Baltimore Veteran Affairs Medical Center, Geriatrics Research Education and Clinical Center, Baltimore, Maryland 21201, USA
| | - Gregory Steinbrenner
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, USA. ; The Baltimore Veteran Affairs Medical Center, Geriatrics Research Education and Clinical Center, Baltimore, Maryland 21201, USA
| | - Andrew P Goldberg
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, USA
| | - Leslie I Katzel
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, USA. ; The Baltimore Veteran Affairs Medical Center, Geriatrics Research Education and Clinical Center, Baltimore, Maryland 21201, USA
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D'Andrea A, Morello A, Iacono AM, Scarafile R, Cocchia R, Riegler L, Pezzullo E, Golia E, Bossone E, Calabrò R, Russo MG. Right Ventricular Changes in Highly Trained Athletes: Between Physiology and Pathophysiology. J Cardiovasc Echogr 2015; 25:97-102. [PMID: 28465945 PMCID: PMC5353418 DOI: 10.4103/2211-4122.172486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Several studies have described the adaptive remodeling of the heart during exercise. In some more practiced endurance athletes, there is a disproportionate load on the right ventricle (RV), at least during exercise, and this might be the basis for a chronic pro-arrhythmic RV remodeling. Especially, in these kinds of athletes the recovery after detraining might be incomplete, in particular for RV changes. The observation of acute myocardial injury based on transient elevation of biomarkers and chronic myocardial scar, not completely reversible changes of the RV and an increased prevalence of some arrhythmias support the existence of an “exercise-induced cardiomyopathy.” The aim of this paper is to review current knowledge about changes in the right heart in highly trained athletes and how these change influence cardiac function.
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Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Alberto Morello
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Agostino Mattera Iacono
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Raffaella Scarafile
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Rosangela Cocchia
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Lucia Riegler
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Enrica Pezzullo
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Enrica Golia
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Eduardo Bossone
- Department of Heart, Cardiology Division, Cava de' Tirreni and Amalfi Coast Hospital, University of Salerno, Salerno, Italy
| | - Raffaele Calabrò
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Integrated Diagnostic Cardiology, AORN dei Colli, Second University of Naples, Naples, Italy
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Pennell DJ, Baksi AJ, Kilner PJ, Mohiaddin RH, Prasad SK, Alpendurada F, Babu-Narayan SV, Neubauer S, Firmin DN. Review of Journal of Cardiovascular Magnetic Resonance 2013. J Cardiovasc Magn Reson 2014; 16:100. [PMID: 25475898 PMCID: PMC4256918 DOI: 10.1186/s12968-014-0100-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 01/19/2023] Open
Abstract
There were 109 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2013, which is a 21% increase on the 90 articles published in 2012. The quality of the submissions continues to increase. The editors are delighted to report that the 2012 JCMR Impact Factor (which is published in June 2013) has risen to 5.11, up from 4.44 for 2011 (as published in June 2012), a 15% increase and taking us through the 5 threshold for the first time. The 2012 impact factor means that the JCMR papers that were published in 2010 and 2011 were cited on average 5.11 times in 2012. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25% and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley John Pennell
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
| | - Arun John Baksi
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
| | - Philip John Kilner
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
| | - Raad Hashem Mohiaddin
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
| | - Sanjay Kumar Prasad
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
| | - Francisco Alpendurada
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
| | - Sonya Vidya Babu-Narayan
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
| | | | - David Nigel Firmin
- />Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- />Imperial College, London, UK
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Levine BD. Can intensive exercise harm the heart? The benefits of competitive endurance training for cardiovascular structure and function. Circulation 2014; 130:987-91. [PMID: 25223769 DOI: 10.1161/circulationaha.114.008142] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Benjamin D Levine
- From the University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
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45
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Elliott AD, La Gerche A. The right ventricle following prolonged endurance exercise: are we overlooking the more important side of the heart? A meta-analysis. Br J Sports Med 2014; 49:724-9. [PMID: 25281542 DOI: 10.1136/bjsports-2014-093895] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/04/2022]
Abstract
AIMS Prolonged endurance exercise is associated with elevated biomarkers associated with myocardial damage and modest evidence of left ventricular (LV) dysfunction. Recent studies have reported more profound effects on right ventricular (RV) function following endurance exercise. We performed a meta-analysis of studies reporting RV function pre-endurance and postendurance exercise. METHODS We performed a search of peer-reviewed studies with the criteria for inclusion in the analysis being (1) healthy adult participants; (2) studies examining RV function following an event of at least 90 min duration; (3) studies reporting RV fractional area change (RVFAC), RV strain (S), RV ejection fraction (RVEF) or tricuspid annular plane systolic excursion (TAPSE) and (4) studies evaluating RV function immediately (<1 h) following exercise. RESULTS Fourteen studies were included with 329 participants. A random-effects meta-analysis revealed significant impairments of RV function when assessed by RVFAC (weighted mean difference (WMD) -5.78%, 95% CI -7.09% to -4.46%), S (WMD 3.71%, 95% CI 2.79% to 4.63%), RVEF (WMD -7.05%, 95% CI -12.3% to -1.8%) and TAPSE (WMD -4.77 mm, 95% CI -8.3 to -1.24 mm). Modest RV dilation was evident in studies reporting RV systolic area postexercise (WMD 1.79 cm(2), 95% CI 0.5 to 3.08 cm(2)). In contrast, no postexercise changes in LV systolic function (expressed as LVFAC or LVEF) were observed in the included studies (standardised mean difference 0.03%, 95% CI -0.13% to 0.18%). CONCLUSIONS Intense prolonged exercise is associated with a measurable reduction in RV function while LV function is relatively unaffected. Future studies should examine the potential clinical consequences of repeated prolonged endurance exercise on the right ventricle.
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Affiliation(s)
- Adrian D Elliott
- School of Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Andre La Gerche
- St Vincent's Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Rodriguez-Reyna TS, Morelos-Guzman M, Hernandez-Reyes P, Montero-Duarte K, Martinez-Reyes C, Reyes-Utrera C, Vazquez-La Madrid J, Morales-Blanhir J, Nunez-Alvarez C, Cabiedes-Contreras J. Assessment of myocardial fibrosis and microvascular damage in systemic sclerosis by magnetic resonance imaging and coronary angiotomography. Rheumatology (Oxford) 2014; 54:647-54. [DOI: 10.1093/rheumatology/keu350] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Leischik R, Spelsberg N. Endurance sport and "cardiac injury": a prospective study of recreational ironman athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9082-100. [PMID: 25192145 PMCID: PMC4199008 DOI: 10.3390/ijerph110909082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 08/18/2014] [Accepted: 08/24/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Participation in triathlon competitions has increased in recent years. Many studies have described left or right ventricular injury in endurance athletes. The goal of this study was to examine the right and left ventricular cardiac structures and function and dynamic cardio-pulmonary performance in a large cohort of middle- and long-distance triathletes. METHODS 87 triathletes (54 male and 33 female) were examined using spiroergometry and echocardiography. The inclusion criterion was participation in at least one middle- or long distance triathlon. RESULTS Male triathletes showed a maximum oxygen absorption of 58.1 ± 8.6 mL/min/kg (female triathletes 52.8 ± 5.7 mL/min/kg), maximum ergometer performance of 347.8 ± 49.9 W (female triathletes 264.5 ± 26.1 W). Left ventricular ejection fraction (EF) was normal (male triathletes EF: 61.9% ± 3%, female triathletes EF: 63.0% ± 2.7%) and systolic right ventricular area change fraction (RV AFC%) showed normal values (males RV AFC%: 33.5% ± 2.2%, females 32.2% ± 2.8%). Doppler indices of diastolic function were normal in both groups. With respect to the echocardiographic readings the left ventricular mass for males and females were 217.7 ± 41.6 g and 145.9 ± 31.3 g, respectively. The relative wall thickness for males was 0.50 ± 0.07, whereas it was 0.47 ± 0.09 for females. The probability of left ventricular mass >220 g increased with higher blood pressure during exercise (OR: 1.027, CI 1.002-1.052, p = 0.034) or with higher training volume (OR: 1.23, CI 1.04-1.47, p = 0.019). CONCLUSIONS Right or left ventricular dysfunction could not be found, although the maximal participation in triathlon competitions was 29 years. A left ventricular mass >220 g is more likely to occur with higher arterial pressure during exercise and with a higher training volume.
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Affiliation(s)
- Roman Leischik
- School of Medicine, Faculty of Health, Witten/Herdecke University, Elberfelder Str. 1, 58095 Hagen, Germany.
| | - Norman Spelsberg
- School of Medicine, Faculty of Health, Witten/Herdecke University, Elberfelder Str. 1, 58095 Hagen, Germany.
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48
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Dalla Vecchia L, Traversi E, Porta A, Lucini D, Pagani M. On site assessment of cardiac function and neural regulation in amateur half marathon runners. Open Heart 2014; 1:e000005. [PMID: 25332775 PMCID: PMC4189300 DOI: 10.1136/openhrt-2013-000005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 12/31/2022] Open
Abstract
Objective Strenuous exercise variably modifies cardiovascular function. Only few data are available on intermediate levels of effort. We therefore planned a study in order to address the hypothesis that a half marathon distance would result in transient changes of cardiac mechanics, neural regulation and biochemical profile suggestive of a complex, integrated adaptation. Methods We enrolled 35 amateur athletes (42±7 years). Supine and standing heart rate variability and a complete echocardiographic evaluation were assessed on site after the completion of a half marathon (postrace) and about 1 month after (baseline). Biochemical tests were also measured postrace. Results Compared to baseline, the postrace left ventricular end-diastolic volume was smaller, peak velocity of E wave was lower, peak velocity of A wave higher, and accordingly the E/A ratio lower. The postrace heart and respiratory rate were higher and variance of RR interval lower, together with a clear shift towards a sympathetic predominance in supine position and a preserved response to orthostasis. At baseline, athletes were characterised by a lower, although still predominant, sympathetic drive with a preserved physiological response to standing. Conclusions Immediately after a half marathon there are clear marks that an elevated sympathetic cardiac drive outlasts the performance, together with decreased left ventricular diastolic volumes and slight modifications of the left ventricular filling pattern without additional signs of diastolic dysfunction or indices of transient left or right ventricular systolic abnormalities. Furthermore, no biochemical indices of any permanent cardiac damage were found.
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Affiliation(s)
- Laura Dalla Vecchia
- IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Milano , Milan , Italy
| | - Egidio Traversi
- IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Montescano , Pavia , Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health , Galeazzi Orthopedic Institute, University of Milan , Milan , Italy
| | - Daniela Lucini
- IRCCS Istituto Clinico Humanitas, Sezione Medicina dell'Esercizio e Sindromi Funzionali, Rozzano , Milan , Italy ; Centro di ricerca Terapia Neurovegetativa e Medicina dell'esercizio, University of Milan, U.O. Telemedicina e Medicina dello Sport, Ospedale 'Luigi Sacco' , Milano , Italy
| | - Massimo Pagani
- Centro di ricerca Terapia Neurovegetativa e Medicina dell'esercizio, University of Milan, U.O. Telemedicina e Medicina dello Sport, Ospedale 'Luigi Sacco' , Milano , Italy
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49
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50
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Pennell DJ, Baksi AJ, Carpenter JP, Firmin DN, Kilner PJ, Mohiaddin RH, Prasad SK. Review of Journal of Cardiovascular Magnetic Resonance 2012. J Cardiovasc Magn Reson 2013; 15:76. [PMID: 24006874 PMCID: PMC3847143 DOI: 10.1186/1532-429x-15-76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 02/07/2023] Open
Abstract
There were 90 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2012, which is an 8% increase in the number of articles since 2011. The quality of the submissions continues to increase. The editors are delighted to report that the 2011 JCMR Impact Factor (which is published in June 2012) has risen to 4.44, up from 3.72 for 2010 (as published in June 2011), a 20% increase. The 2011 impact factor means that the JCMR papers that were published in 2009 and 2010 were cited on average 4.44 times in 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley J Pennell
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - A John Baksi
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - John Paul Carpenter
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - Philip J Kilner
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - Raad H Mohiaddin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - Sanjay K Prasad
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
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