Impact of specific training and competition on myocardial structure and function in different age ranges of male handball players

Abstract

Handball activity involves cardiac changes and demands a mixture of both eccentric and concentric remodeling within the heart. This study seeks to explore heart performance and cardiac remodeling likely to define cardiac parameters which influence specific performance in male handball players across different age ranges. Forty three players, with a regular training and competitive background in handball separated into three groups aged on average 11.78±0.41 for youth players aka “schools”, “elite juniors” 15.99±0.81 and “elite adults” 24.46±2.63 years, underwent echocardiography and ECG examinations. Incremental ergocycle and specific field (SFT) tests have also been conducted. With age and regular training and competition, myocardial remodeling in different age ranges exhibit significant differences in dilatation’s parameters between “schools” and “juniors” players, such as the end-diastolic diameter (LVEDD) and the end-systolic diameter of the left ventricle (LVESD), the root of aorta (Ao) and left atrial (LA), while significant increase is observed between “juniors” and “adults” players in the interventricular septum (IVS), the posterior wall thicknesses (PWT) and LV mass index. ECG changes are also noted but NS differences were observed in studied parameters. For incremental maximal test, players demonstrate a significant increase in duration and total work between “schools” and “juniors” and, in total work only, between “juniors” and “seniors”. The SFT shows improvement in performance which ranged between 26.17±1.83 sec to 31.23±2.34 sec respectively from “seniors” to “schools”. The cross-sectional approach used to compare groups with prior hypothesis that there would be differences in exercise performance and cardiac parameters depending on duration of prior handball practice, leads to point out the early cardiac remodeling within the heart as adaptive change. Prevalence of cardiac chamber dilation with less hypertrophy remodeling was found from “schools” to “juniors” while a prevalence of cardiac hypertrophy with less pronounced chamber dilation remodeling was noted later.

Echocardiographic assessment of children participating in regular sports training

“…Similarly, a study in which participants were divided into groups according to training hours per week reported that IVS thickness, end-diastolic diameter, and left ventricular mass were significantly higher in athletes whose training exceeded 8 h/week than in controls [22]. Agrebi et al reported that among children who were having a regular training for handball, LVEDd, LVESd, LA, AR, and LV mass are all significantly lower in younger children than in older ones and adults [23]. This finding was suggested to be associated with the duration of prior practice and early cardiac remodeling.…”

Potential adverse cardiac remodelling in highly trained athletes: still unknown clinical significance

“…(2016) reported an increment in right ventricular size parameters during active training with no significant changes in functional echocardiographic parameters. Finally, aortic root size showed an increment related to the athlete's age (Agrebi, Tkatchuk, Hlila, Mouelhi, & Belhani, 2015) and probably not a consequence of exercise training.…”

Cardiac Adaptation in Performance Athletes: A Systematic Review

“…The results of the reviewed studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] are presented in Tables 1-3.…”

“…Two studies reported that male athletes met the diagnostic criteria for LVH more frequently [14,17]; one recorded RVH as less common than LVH [17]. One study showed that the duration of the PR interval increases with age but remains within normal limits [16]. Finocchiaro et al [14] found that 4% of the participants presented a left-axis deviation, and 33% of the male athletes they studied had a QRS duration >100ms.…”

“…Out of the 17 original studies that were eligible for this review, four studies showed relevant data regarding ECG findings [12,14,16,17]. Two studies reported that male athletes met the diagnostic criteria for LVH more frequently [14,17]; one recorded RVH as less common than LVH [17].…”