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Fabian A, Lakatos B, Tokodi M, Kiss O, Babity M, Bognar C, Sydo N, Csulak E, Vago H, Merkely B, Kovacs A. Mechanical diversity in the adaptation of left and right ventricular function to long-term exercise: 3D echocardiographic study in a large cohort of competitive athletes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Regular physical exercise results in complex remodelling of the left- (LV) and right ventricle (RV), commonly referred as the athlete's heart. Despite the well-known changes in ventricular volumes and mass, data are scarce regarding ventricular mechanics and its connection to exercise performance.
Accordingly, our aim was to characterize biventricular morphological and functional changes and their association with peak exercise capacity in a large cohort of athletes using three-dimensional (3D) echocardiography.
Competitive athletes of various training regimes (n=525, age: 20±6 years, training: 15±7 hours/week, 30% female) were enrolled, while 73 age- and gender-matched sedentary volunteers served as the control group. Full volume 3D echocardiographic datasets focused on the LV or the RV were acquired for further analysis: LV and RV end-diastolic volume (EDVi), LV mass (Mi) indices and ejection fraction (EF) were quantified. To characterize biventricular mechanics, LV and RV global longitudinal strain (GLS) and global circumferential strain (GCS) were also measured using dedicated software. Athletes also underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg).
Athletes had significantly higher LV and RV EDVi (81±13 vs. 64±11 mL/m2; 83±14 vs. 63±11 mL/m2; both p<0.001) and also LVMi (87±15 vs. 65±12 g/m2; p<0.001) compared to controls. LV and RV EF were significantly lower in athletes (57±5 vs. 60±6%; 55±5 vs. 58±5%; both p<0.001). LV GLS (−19.5±2.1 vs. −20.6±2.6%; p<0.001) and also LV GCS (−27.9±3.2 vs. −29.8±4.4%; p<0.001) was lower in athletes compared to controls. In opposed to the LV, RV GLS did not differ between the two groups (−29.3±5.8 vs. −29.5±5.3%; p=NS), however, RVGCS was decreased in athletes compared to controls (−24.4±6.1 vs. −28.6±7.3%; p<0.001). In athletes, ventricular morphology measured by LV and RV EDVi correlated with VO2/kg (both r=0.37; p<0.001), while functional measures, such as lower resting LV GLS (r=0.22; p<0.001) and RV GCS (r=0.14; p<0.01) also showed relationship with better exercise performance.
According to our results, regular physical exercise is associated with significant changes of LV and RV geometry and mechanics. Resting biventricular systolic function of the athlete's heart is characterized by a mild reduction, which is attributable to a lower longitudinal and circumferential shortening on the left side of the heart, while on the right side lower circumferential shortening can be seen along with a maintained longitudinal shortening. Moreover, this mechanical pattern also correlates with exercise performance.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): “National Heart Program” NVKP_16-1-2016-0017; NKFIH K_16 K120277 to BM
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Affiliation(s)
- A Fabian
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B.K Lakatos
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - M Tokodi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - O Kiss
- Semmelweis University, Department of Sports Medicine, Budapest, Hungary
| | - M Babity
- Semmelweis University, Department of Sports Medicine, Budapest, Hungary
| | - C Bognar
- Semmelweis University, Department of Sports Medicine, Budapest, Hungary
| | - N Sydo
- Semmelweis University, Department of Sports Medicine, Budapest, Hungary
| | - E Csulak
- Semmelweis University, Department of Sports Medicine, Budapest, Hungary
| | - H Vago
- Semmelweis University, Department of Sports Medicine, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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Lakatos BK, Kiss O, Sydo N, Tokodi M, Fabian A, Kantor Z, Bognar C, Major D, Kovacs A, Merkely B. P947 Left- and right ventricular mechanics in athletes: a true marker of fitness? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Regular physical exercise results in marked changes of ventricular morphology and function, also referred as the athlete’s heart. Despite the marked changes of cardiac morphology and function in athletes, data is scarce regarding the relationship between exercise performance and cardiac adaptation to exercise.
Accordingly, our aim was to examine the relationship between ventricular morphology and function and exercise capacity in a prospective cohort study.
Young elite soccer players (n = 18, age: 16 ± 1 years) were enrolled and examined at baseline and following 1 year. Athletes underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Following exercise testing, 3D echocardiography was performed and LV and RV focused loops were obtained. By off-line analysis, we measured left- (LV) and right ventricular (RV) end-diastolic volume indices (EDVi) and LV mass index (LVMi) indexed to body surface area and LV and RV ejection fractions (EF). By 3D speckle-tracking analysis of the LV and RV we also determined global longitudinal (GLS) and circumferential (GCS) strains.
We found improved and decreased peak exercise performance as well during the 1 year follow-up with an overrall increased mean exercise capacity (dVO2/kg: 2.6 ± 7.3 ml/min/kg). LV and RV morphology did not change significantly according to LVEDVi and RVEDVi (LVEDVi: 84 ± 14 vs. 80 ± 7 ml/ m², RVEDVi: 82 ± 11 vs. 84 ± 10 ml/m², both p = NS). LVMi significantly increased (82 ± 14 vs. 89 ± 9 g/m², p < 0.001). LV and RV EF did not change during one year follow-up (LVEF: 58 ± 4 vs. 57 ± 5%; RVEF: 57 ± 4 vs. 55 ± 6%, both p = NS), while LVGLS decreased compared to baseline (19.7 ± 1,8 vs. 19.3 ± 2,8%, p < 0.01). The change in VO2/kg showed correlation with decreased LVGLS and also with decreased RVGCS (dLVGLS vs. dVO2/kg: r=-0.56, dRVGCS vs. dVO2/kg: r=-0.50, both p < 0.05)
During 1 year follow-up cardiac morphology and function significantly changed in our athlete cohort, and these changes showed relationship with the changes of peak exercise performance. Detailed assessment of myocardial mechanics may help to monitor training in athletes.
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Affiliation(s)
| | - O Kiss
- Semmelweis University, Budapest, Hungary
| | - N Sydo
- Semmelweis University, Budapest, Hungary
| | - M Tokodi
- Semmelweis University, Budapest, Hungary
| | - A Fabian
- Semmelweis University, Budapest, Hungary
| | - Z Kantor
- Semmelweis University, Budapest, Hungary
| | - C Bognar
- Semmelweis University, Budapest, Hungary
| | - D Major
- Semmelweis University, Budapest, Hungary
| | - A Kovacs
- Semmelweis University, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Budapest, Hungary
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Padua T, Monteiro M, Silvino M, Carvalho L, Sousa T, Bognar C, Brabo E, Campelo M, Limeira D, Abrahao A, Zukin M, Moreira R, Araújo L. P1.09-04 Comprehensive Genomic Profiling in a Brazilian Cohort of Lung Cancer Patients: Real-World Impact. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Luiz F, Abrahao A, Silva E, Bognar C, Monteiro M, Moreira R, Padua T. EP1.15-25 A Rare Case of Metastatic Leiomyoma of the Lung. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lakatos BK, Kiss O, Tokodi M, Toser Z, Sydo N, Komocsin Z, Szilagyi M, Babity M, Bognar C, Major D, Merkely B, Kovacs A. 3081Exercise-induced shift in right ventricular contraction pattern: novel marker of athlete's heart? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B K Lakatos
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - O Kiss
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - M Tokodi
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Z Toser
- Argus Cognitive, Inc., Dover, United States of America
| | - N Sydo
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Z Komocsin
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - M Szilagyi
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - M Babity
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - C Bognar
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - D Major
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
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