In our previous review characteristics of the athlete's heart were divided into three groups: morphologic (left ventricular (LV) hypertrophy, improved coronary circulation), functional (better diastolic function) and regulatory (lower heart rate (HR)) features. In the present review, the influences of the types of sports and the age on the athlete's heart are discussed. Studies using echocardiographic, Doppler-echocardiographic, tissue Doppler imaging (TDI) and magnetic resonance imaging (MRI) results are mostly involved. The coronary circulation was investigated overwhelmingly in animal experiments. In the LV hypertrophy a major contributor is the increase of the LV wall thickness (WT) than that of the LV internal diameter (ID). A right ventricular (RV) hypertrophy can also be seen in athletes. Athletic features are induced mostly by endurance training. Approximately two years regular physical training is needed to develop characteristics of the athlete's heart, hence, in the young children they are less marked. LV hypertrophy and lower HR are characteristic in young and adult athletes, but they are less marked in older ones. A richer coronary capillary network can develop mostly at a young age.

Characteristics of the athlete's heart have been investigated mostly in the left ventricle (LV); reports referring to the right ventricle (RV) have only appeared recently. The aim of the present study was to compare the training effects on RV and LV in elite male endurance athletes. To this end, echocardiography was conducted in 52 elite endurance athletes (A) and in 25 non-athletes (NA). Differences between A and NA in the morphology was more marked in the RV (body-size-matched (rel.)) long axis diastolic diameter (RVLADd): 63.4 ± 6.3 vs. 56.4 ± 6.3; rel. short axis diastolic diameter (RVSADd): 27.3 ± 3.6 vs. 23.6 ± 2.7 mm/m, RV diastolic area 28 ± 5.0 vs. 21.3 ± 4.3 cm 2 in all cases, p < 0.001) than in the LV (rel. LVLADd: 63.8 mm/m ± 5.6 vs. 60.7 mm/m ± 6.6, p < 0.05, rel.LVSADd 37.8 ± 3.1 vs. 35.3 ± 2.4, no difference). In the athletes ratios of peak early to late diastolic filling velocity (2.07 ± 0.51 vs. 1.75 ± 0.36, p < 0.01), the TDI-determined E'/A' ratio in the septal (1.89 ± 0.55 vs. 1.62 ± 0.55, p < 0.05) and lateral (2.62 ± 0.72, vs. 2.18 ± 0.87, p < 0.001) walls were significantly higher than in NA only in the LV. Results indicate that in male endurance athletes morphologic adaptation is similar or slightly stronger in the RV than in the LV, functional adaptation seems to be stronger in the LV.

Background/Aims: Little is known about the effect of twice daily administration of same dose of ACE inhibitor and ARB on the diurnal/nocturnal blood pressure (BP) ratio. We aimed to assess the effect of two widely used long-acting drugs: perindopril and losartan in the treatment of hypertension comparing the once-daily (evening) vs. twice-daily (morning and evening) administration with the same daily doses. Methods: Untreated primary hypertensive patients without complaints (a total of 164: 65 men, 99 women, 55.7±13.7 years of age, 41-41 patients per treated groups) were selected with non-dipper phenomenon, estimated by diurnal index (DI) <10%. The effect of evening (8 mg perindopril or 100 mg losartan) vs morning and evening (4-4 mg perindopril or 50-50 mg losartan) administration was determined on a 14-day treatment by ABPM. Results: The mean BP, the percent time elevation index, and the hyperbaric impact decreased in both drug groups. Significant difference was observed in the DI in the case of twice-daily administration vs once-daily evening dosing. Conclusions: The twice-daily administration with the same daily dose of perindopril or losartan seems to be more effective compared to the once daily evening administration in eliminating the non-dipper phenomenon. According to some authors the non-dipping phenomenon increases cardiovascular risk, while others are of the opinion that the association of non-dipping with cardiovascular events does not necessarily mean that selective treatment of non-dipping improves cardiovascular outcomes.

Training adaptation of the left ventricle (LV) and it's reversibility following the cessation of training in adults is well known and also studied in children. In the current study we describe the changes in the LV morphology in association with the training season during a 1.5 year follow-up period. 15 elite adolescent swimmers, seven girls and 8 boys with 6 years of swimming history and 20 hr per week training were observed. Their data were compared with 15 age and gender matched nonathletes. LV adaptation was measured with 2D-echocardiography at the baseline preseason and every 3 months, according to the macro cyclic periods of training. Nonathletes were observed at the first and fifth stage of the study. Remarkable LV morphological adaptation has been detected in the swimmers. The greatest LV muscle mass (LVMM: 228 ± 46g) and smallest end-diastolic diameter (LVIDd:44.9 ± 3.4mm) were observed at the end of the second general endurance preparation period (GEP2), but the LVMM/BSA (Rel.LVMM: 85 ± 10g/m) failed to change during the follow-up in athletes. On the basis of our results, we suggest comparing absolute LV dimensions only in studies made at the same training period to avoid bias due to alterations with the training season.

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