Exercise hypertension: Link to myocardial fibrosis in athletes?

Halle, Martin; Esefeld, Katrin; Schindler, M; Schunkert, Heribert

doi:10.1177/2047487319868795

Cited by 15 publications

(5 citation statements)

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“…In the absence of a fixed maximal workload (A), the influence of cardiorespiratory fitness is obscured, hindering correct clinical inter-of incident hypertension (44). Others have also suggested that the training-induced transient and repetitive nature of EEBP in well-trained athletes may be a portent to subtle myocardial fibrosis preceding future "pathological" CVD such as atrial fibrillation (45). Moreover, EEBP thresholds during maximal exercise are reported higher in well-trained populations (SBP values >220 mm Hg for men and >200 mm Hg for women) (46,47).…”

Section: Maximal Exercise Workloadsmentioning

confidence: 99%

Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing

Schultz

Gerche

Sharman

2021

Exercise and Sport Sciences Reviews

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Section: Maximal Exercise Workloadsmentioning

confidence: 99%

Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing

Schultz

Gerche

Sharman

2021

Exercise and Sport Sciences Reviews

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“…The current study shows, that athletes with ischemic LGE due to unrecognized myocardial infarction are at increased risk for SCD. Athletes with ischemic LGE were characterized by an increased systolic blood pressure under exercise and an increased LV mass index on CMR compared to athletes without LGE indicating relevant structural alterations of the LV myocardium most likely due to repetitive LV pressure overload during exercise [ 11 ]. However, athletes with major non-ischemic LGE were also characterized by a higher number of exercise-induced hypertension and an increased LV mass index similar to that of athletes with ischemic LGE.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Relevance of Ischemic Late Gadolinium Enhancement in Apparently Healthy Endurance Athletes: A Follow-up Study Over 5 years

Lund,

Leptin,

Ragab

et al. 2024

Sports Med - Open

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Background In many cardiac diseases, myocardial scar tissue detected by late gadolinium enhancement (LGE) is a risk factor for cardiac arrhythmia and sudden cardiac death. Previous studies in athletes reported an increased risk for cardiac events in this group of ostensibly healthy subjects. However, the currently available longitudinal studies on this topic included fairly old marathon runners with a mean age of 57 ± 6 years or represent a case–control study in athletes with preexisting ventricular arrhythmia. The purpose of this prospective study was to analyze the prognostic relevance of LGE cardiac magnetic resonance (CMR) in middle-aged endurance athletes without known preexisting cardiac disorders. Methods Three-hundred and twelve apparently healthy athletes were prospectively enrolled. Inclusion criteria were a training for a minimum of 10 h per week and regularly participation in competitions. LGE CMR was obtained at baseline in all athletes and presence of LGE was classified visually according to established criteria as ischemic LGE, major or minor non-ischemic LGE or absent LGE. Follow-up consisted of a standardized questionnaire and an additional phone call in case of incomplete data. An event was defined as fatal myocardial infarction, ventricular tachycardia, ventricular fibrillation or sudden cardiac death (SCD). Results Complete follow-up was available for 293/312 athletes (94%) including 145 triathletes, 74 marathon runners and 74 cyclists after a median of 5.6 [quartiles 4,3, 6,4] years. Median age was 44 [35, 50] years at study enrollment. Spiroergometry did not reveal heart rhythm disturbances or significant ECG changes in the study population. LGE CMR revealed myocardial scar/focal fibrosis in 80 of 293 athletes (27%) including 7 athletes (2%) with ischemic subendocardial LGE of the left ventricle (LV), 16 athletes (6%) with major non-ischemic LGE of the LV and 57 athletes (19%) with minor non-ischemic LGE. During follow-up, two athletes experienced SCD. One marathon runner died during a training run and one cyclist died suddenly at rest. Both athletes had ischemic LGE of the LV. The event rate for SCD was 0.7% in the entire study population and 28% in the 7 athletes with ischemic LGE (p < 0.001 compared to athletes without LGE). Conclusions Our findings indicate that athletes with ischemic LGE due to unrecognized myocardial infarction are at increased risk for SCD. Our findings highlight the value of LGE CMR to detect occult ischemic scar in asymptomatic apparently healthy athletes, which is of importance, since current guidelines do not recommend to incorporate routine cardiac imaging in pre-participation screening. Athletes with ischemic myocardial scar should at least consider to refrain from high-level exercise as an individual decision.

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“…Allerdings zeigen sich entgegengesetzte Daten, d. h. dass jahrelanger Ausdauersport sogar Atherosklerose der Koronararterien begünstigen kann, auch wenn die dort entstehenden Plaques tendenziell kalkreicher sind im Vergleich zur untrainierten Vergleichsgruppe und somit einem niedrigeren Risiko einer Plaqueruptur unterliegen [ 10 ]. Als proatherosklerotischer Pathomechanismus wird – in Kombination mit einer Hypercholesterinämie – im Rahmen des Blutdruckanstiegs unter Trainingsbelastungen eine verstärkte Bildung turbulenter Strömungen im Abzweigungsbereich der großen Koronararterien angenommen [ 11 ].…”

Section: Sportkardiologische Aspekte Bei Koronarer Herzerkrankungunclassified

Sportkardiologie

Stegmüller

Dinter

Ritzer

et al. 2022

Herz

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Exercise hypertension: Link to myocardial fibrosis in athletes?

Cited by 15 publications

References 50 publications

Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing

Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing

Prognostic Relevance of Ischemic Late Gadolinium Enhancement in Apparently Healthy Endurance Athletes: A Follow-up Study Over 5 years

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