Cardiac remodelling: concentric versus eccentric hypertrophy in strength and endurance athletes

Abstract

Cardiac remodelling is commonly defined as a physiological or pathological state that may occur after conditions such as myocardial infarction, pressure overload, idiopathic dilated cardiomyopathy or volume overload. When training excessively, the heart develops several myocardial adaptations causing a physiological state of cardiac remodelling. These morphological changes depend on the kind of training and are clinically characterised by modifications in cardiac size and shape due to increased load. Several studies have investigated morphological differences in the athlete's heart between athletes performing strength training and athletes performing endurance training. Endurance training is associated with an increased cardiac output and volume load on the left and right ventricles, causing the endurance-trained heart to generate a mild to moderate dilatation of the left ventricle combined with a mild to moderate increase in left ventricular wall thickness. Strength training is characterised by an elevation of both systolic and diastolic blood pressure. This pressure overload causes an increase in left ventricular wall thickness. This may or may not be accompanied by a slight raise in the left ventricular volume. However, the development of an endurancetrained heart and a strength-trained heart should not be considered an absolute concept. Both forms of training cause specific morphological changes in the heart, dependent on the type of sport. (Neth Heart J 2008;16:129-33.).

Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy

“…Several pathophysiologic mechanisms have been suggested, nevertheless there is paucity of clinical markers that can characterize a hemodynamic milieu predictive of the risk of cardiac remodeling either following infarction (Nijveldt et al, 2009;Wu et al, 2008) or excessive sport activity (De Luca et al, 2011;Mihl et al, 2008).…”

Computational modeling of the electromechanical response of a ventricular fiber affected by eccentric hypertrophy

“…In the whole heart, eccentric hypertrophy is an organ response to a longterm volume overload caused by physiological or pathological factors [1,2]. This yields a dilation of ventricles with a negligible wall thinning.…”

Accuracy of the Electrocardiograph in Detecting Cardiac Left Ventricular Hypertrophy in Pediatric Patients with Aortic Valve Disease

“…Changes associated with LVH include cardiac fibrosis and remodeling, as well as cardiomyocyte hypertrophy [2]. LVH typically arises as a compensatory mechanism against a chronic increase in cardiac workload, though neurochemical and hormonal stimuli have also been implicated, including mediators such as cardiotrophin -1 and parathyroid hormone [3][4][5].…”

“…Pressure-induced hypertrophy induces concentric hypertrophy (thickening of cardiac muscle without dilatation), while volumemediated hypertrophy is termed eccentric hypertrophy, or left ventricular dilatation (LVD) [6]. The difference between these forms of hypertrophy stems from the addition of sarcomeric units added in series (eccentric) or in parallel (concentric) [2]. A moderate level of LVH is observed to arise naturally in response to exercise, but even this can progress to a condition known as athlete's heart where individuals demonstrate some risk for adverse cardiac events [7].…”