Absence of cardiac damage induced by long-term intensive endurance exercise training: A cardiac magnetic resonance and exercise echocardiography analysis in masters athletes

Missenard, Olivier; Gabaudan, C.; Astier, Hélène; Desmots, F.; Garnotel, Éric; Massoure, Pierre‐Laurent

doi:10.1016/j.ajpc.2021.100196

Cited by 7 publications

(6 citation statements)

References 46 publications

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“…It is possible that these training regimens, which are against natural behavior for rodents, lead to another phenotype that elicits a stress-related impact which could play a pivotal role, e.g., influencing the development of fibrosis. Our findings concerning fibrosis align with relatively large studies in human athletes, which did not detect any signs of cardiac fibrosis using cardiac magnetic resonance imaging [ 22 , 24 , 73 ]. Other studies, including both veteran and young elite athletes, did find minor fibrotic changes in the ventricles that differed from the general population [ 23 , 25 , 26 ], but no atrial findings were reported.…”

Section: Discussionsupporting

confidence: 90%

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Long-Term Training Increases Atrial Fibrillation Sustainability in Standardbred Racehorses

Carstensen

Nissen

Saljic

et al. 2023

J. of Cardiovasc. Trans. Res.

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Atrial fibrillation (AF) is more prevalent in athletes, and currently, the mechanisms are not fully understood. Atrial fibrillation inducibility and stability was investigated in trained and untrained Standardbred racehorses. The horses underwent echocardiography for evaluation of atrial size. High-density mapping during AF was performed, and the presence of structural remodeling, as well as the expression of inflammatory and pro-inflammatory markers in the atria, was studied. Atrial fibrillation sustained significantly longer after tachypacing in the trained horses, whereas no difference in AF inducibility was found. The untrained horses displayed a significant difference in the AF complexity when comparing right and left atria, whereas such difference was not observed in the trained animals. No evidence of increased structural remodeling or inflammation could be identified. Left atrial dimensions were not significantly increased. The increased AF sustainability in trained horses was not related to fibrosis or inflammation as seen in other animal exercise models. Graphical abstract

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Section: Discussionsupporting

confidence: 90%

“…Whether human athletes develop atrial cardiac fibrosis after long-term training has been investigated. However, the results are contradicting and substantial atrial fibrotic development in humans is unlikely [ 22 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Training Increases Atrial Fibrillation Sustainability in Standardbred Racehorses

Carstensen

Nissen

Saljic

et al. 2023

J. of Cardiovasc. Trans. Res.

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“…In this regard, although the analyzed sample size was small and this could limit the robustness of our findings, we found no significant differences between former cyclists who were still sustaining a strenuous training regime (~13 h·wk −1 ) and their untrained peers. It must also be noted that other studies have failed to report an increased prevalence of myocardial fibrosis among endurance athletes, even among who had performed lifelong SEE (11–13,30). Notably, Abdullah et al (11) found no evidence of myocardial fibrosis in a cohort of 21 master athletes age ~68 yr who were still sustaining high SEE training loads (6–7 weekly sessions).…”

Section: Discussionmentioning

confidence: 97%

Myocardial Fibrosis and Coronary Calcifications Caused by Endurance Exercise? Insights from Former Professional Cyclists

Maceira¹,

Santos‐Lozano

García-González³

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose: This study aimed to compare the prevalence of myocardial fibrosis and coronary calcification in individuals who have performed very high levels of strenuous endurance exercise (SEE; former male professional cyclists) and sex/age-matched controls. Methods: We used a retrospective cohort study design, where cases were former finishers of ≥1 Grand Tour (Tour de France, Giro d' Italia or Vuelta a España) and controls were untrained individuals free of cardiovascular risk. All participants underwent cardiac magnetic resonance and cardiac computer tomography in the same center during years 2020-2021 to detect myocardial fibrosis (late gadolinium enhancement) and to quantify coronary calcium, respectively. Results: Twenty-three cases (age, 46 ± 6 yr) and 59 controls (47 ± 7 yr) were studied. Fibrotic patches were evidenced only in the left ventricle, with a higher prevalence in cases (23% vs 2% in controls, P = 0.006). However, fibrotic tissue was nonischemic and of low extension (0.6% ± 0.4% of left ventricle mass), and no significant differences were found between cases and controls for native T1 or T2 values. No between-group differences were found for coronary calcium indicators, including Agatston or density scores. Subanalyses revealed no differences attending to whether cases were still performing regular SEE (n = 8) or not (n = 15) after professional retirement. Conclusions: Although former professional cyclists seemed to show a greater prevalence of myocardial fibrosis, the extension of fibrotic tissue was minimal and no alterations were found in coronary calcification indicators. While keeping in mind the low sample size of the cases' group, our results do not support evidence for major cardiac maladaptations with long-term exposure to SEE, at least in middle-age adults.

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“…This was corroborated by a recent meta-analysis ( 31 ). Yet, the evidence regarding this matter is not unequivocal: other studies found a correlation with age (although age and training load per definition go hand in hand) ( 32 ) or no correlation at all ( 33 , 34 ). Future studies are underway to shed more light on this matter, along with the clinical relevance of such LGE patterns ( 17 ).…”

Section: Discussionmentioning

confidence: 97%

Low rates of myocardial fibrosis and ventricular arrhythmias in recreational athletes after SARS-CoV-2 infection

Miljoen,

Favere,

Van De Heyning

et al. 2024

Front. Cardiovasc. Med.

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IntroductionHigh rates of cardiac involvement were reported in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. This led to anxiety in the athletic population. The current study was set up to assess the prevalence of myocardial fibrosis and ventricular arrhythmias in recreational athletes with the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.MethodsConsecutive adult recreational athletes (≥18 years old, ≥4 h of mixed type or endurance sports/week) underwent systematic cardiac evaluation after a prior confirmed COVID-19 infection. Evaluation included clinical history, electrocardiogram (ECG), 5-day Holter monitoring, and cardiac magnetic resonance (CMR) imaging with simultaneous measurement of high-sensitive cardiac Troponin I. Data from asymptomatic or mildly symptomatic athletes (Group 1) were compared with those with moderate to severe symptoms (Groups 2–3). Furthermore, a comparison with a historical control group of athletes without COVID-19 (Master@Heart) was made.ResultsIn total, 35 athletes (18 Group 1, 10 female, 36.9 ± 2.2 years, mean 143 ± 20 days following diagnosis) were evaluated. The baseline characteristics for the Group 1 and Groups 2–3 athletes were similar. None of the athletes showed overt myocarditis on CMR based on the updated Lake Louise criteria for diagnosis of myocarditis. The prevalence of non-ischemic late gadolinium enhancement [1 (6%) Group 1 vs. 2 (12%) Groups 2–3; p = 0.603] or ventricular arrhythmias [1 Group 1 athlete showed non-sustained ventricular tachycardia (vs. 0 in Groups 2–3: p = 1.000)] were not statistically different between the groups. When the male athletes were compared with the Master@Heart athletes, again no differences regarding these criteria were found.ConclusionIn our series of recreational athletes with prior confirmed COVID-19, we found no evidence of ongoing myocarditis, and no more detection of fibrosis or ventricular arrhythmias than in a comparable athletic pre-COVID cohort. This points to a much lower cardiac involvement of COVID-19 in athletes than originally suggested.

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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

Cited by 7 publications

References 46 publications

Long-Term Training Increases Atrial Fibrillation Sustainability in Standardbred Racehorses

Long-Term Training Increases Atrial Fibrillation Sustainability in Standardbred Racehorses

Myocardial Fibrosis and Coronary Calcifications Caused by Endurance Exercise? Insights from Former Professional Cyclists

Low rates of myocardial fibrosis and ventricular arrhythmias in recreational athletes after SARS-CoV-2 infection

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