Exercise-induced cardiac remodeling in non-elite endurance athletes: Comparison of 2-tiered and 4-tiered classification of left ventricular hypertrophy

Abstract

BackgroundLong-term endurance sport practice leads to eccentric left ventricular hypertrophy (LVH). We aimed to compare the new 4-tiered classification (4TC) for LVH with the established 2-tiered classification (2TC) in a cohort of normotensive non-elite endurance athletes.MethodsMale participants of a 10-mile race were recruited and included when blood pressure (BP) was normal (<140/90 mmHg). Phenotypic characterization of LVH was based on relative wall thickness (2TC), and on LV concentricity2/3 (LV mass/end-diastolic volume [LVM/EDV]2/3) plus LVEDV index (4TC). Parameters of LV geometry, BP, cumulative training hours, and race time were compared between 2TC and 4TC by analysis of variance, and post-hoc analysis.ResultsOf 198 athletes recruited, 174 were included. Mean age was 41.6±7.5 years. Forty-two (24%) athletes had LVH. Allocation in the 2TC was: 32 (76%) eccentric LVH and 10 (24%) concentric LVH. Using the 4TC 12 were reclassified to concentric LVH, and 2 to eccentric LVH, resulting in 22 (52%) eccentric LVH (7 non-dilated, 15 dilated), and 20 (48%) concentric LVH (all non-dilated). Based on the 2TC, markers of endurance training did not differ between eccentric and concentric LVH. Based on the 4TC, athletes with eccentric LVH had more cumulative training hours and faster race times, with highest values thereof in athletes with eccentric dilated LVH.ConclusionsIn our cohort of normotensive endurance athletes, the new 4TC demonstrated a superior discrimination of exercise-induced LVH patterns, compared to the established 2TC, most likely because it takes three-dimensional information of the ventricular geometry into account.

Left ventricular remodeling in elite and sub‐elite road cyclists

“…Conventional relative wall thickness (RWT) was calculated using the formula [(IVSWTd + PWTd)/LVd] (where IVSWTd denotes diastolic basal interventricular wall thickness and PWTd denotes diastolic basal posterior wall thickness). LV end‐diastolic volume (LV EDV) and LV end‐systolic volume (LV ESV) were calculated using a Simpsons biplane method, and LV concentricity was calculated as [LV mass/LV EDV 2/3 ] 30 . LV geometry was assessed using a four‐tier method, whereby geometry was defined as (a) normal (LV mass < 116 g/m 2 , concentricity < 9.1 g/mL (2/3)) ), (b) concentric remodeling (LV mass < 116 g/m 2 , concentricity ≥ 9.1 mL (2/3)) ), (c) concentric non‐dilated LVH (LV mass ≥ 116 g/m 2 , concentricity ≥ 9.1 g/mL (2/3) and LV EDV/BSA < 76 mL/m 2 ), (d) concentric dilated LVH (LV mass ≥ 116 g/m 2 , concentricity ≥ 9.1 g/mL (2/3) and LV EDV/BSA ≥ 76 mL/m 2 ), (e) eccentric non‐dilated LVH (LV mass ≥ 116 g/m 2 , concentricity < 9.1 g/mL (2/3) and LV EDV/BSA < 76 mL/m 2 ), and (f) eccentric dilated LVH (LV mass ≥ 116 g/m 2 , concentricity < 9.1 g/mL (2/3) and LV EDV/BSA ≥ 76 mL/m 2 ) as previously described by Trachsel et al 30 Stroke volume (SV) and EF were calculated from LVEDV and LVESV, respectively.…”

Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification

“…The new 4-group classification also showed higher discrimination of exercise-induced LVH patterns in a cohort of normotensive endurance athletes relative to the existing 2-group classification ( 8 ). Besides, other studies tested the association of the 4-group classification with biological markers.…”

“…LV, left ventricular; EDV, end-diastolic volume; BSA, body surface area; LVH, left ventricular hypertrophy; RWT, relative wall thickness; ESC, European association of cardiology; CMR, Cardiac magnetic Resonance. Adapted from ( 8 ).…”

Run for your life: can exercise be used to effectively target GLUT4 in diabetic cardiac disease?

“…The ability of exercise to induce chronic adaptations in cardiac structure and function has also been shown via techniques such as transthoracic echocardiography. The concept of an ‘athlete’s heart’ is well defined; prolonged adherence to exercise training results in hypertrophy of the left ventricular wall ( Trachsel et al, 2018 ). Endurance training may also increase the internal diameter of the left ventricular chamber in response to chronic volume overload (eccentric hypertrophy), whereas more resistance-based training does not (concentric hypertrophy), although few athletes adhere to only one type of training ( Fagard, 1992 ).…”