Rationale and design of the PROspective ATHletic Heart (Pro@Heart) study: long-term assessment of the determinants of cardiac remodelling and its clinical consequences in endurance athletes

Abstract

BackgroundExercise-induced cardiac remodelling (EICR) results from the structural, functional and electrical adaptations to exercise. Despite similar sports participation, EICR varies and some athletes develop phenotypic features that overlap with cardiomyopathies. Training load and genotype may explain some of the variation; however, exercise ‘dose’ has lacked rigorous quantification. Few have investigated the association between EICR and genotype.Objectives(1) To identify the impact of training load and genotype on the variance of EICR in elite endurance athletes and (2) determine how EICR and its determinants are associated with physical performance, health benefits and cardiac pathology.MethodsThe Pro@Heart study is a multicentre prospective cohort trial. Three hundred elite endurance athletes aged 14–23 years will have comprehensive cardiovascular phenotyping using echocardiography, cardiac MRI, 12-lead ECG, exercise-ECG and 24-hour-Holter monitoring. Genotype will be determined using a custom cardiomyopathy gene panel and high-density single-nucleotide polymorphism arrays. Follow-up will include online tracking of training load. Cardiac phenotyping will be repeated at 2, 5, 10 and 20 years.ResultsThe primary endpoint of the Pro@Heart study is the association of EICR with both training load and genotype. The latter will include rare variants in cardiomyopathy-associated genes and polygenic risk scores for cardiovascular traits. Secondary endpoints are the incidence of atrial and ventricular arrhythmias, physical performance and health benefits and their association with training load and genotype.ConclusionThe Pro@Heart study is the first long-term cohort study to assess the impact of training load and genotype on EICR.Trial registration numberNCT05164328; ACTRN12618000716268.

The Prevalence of Cardiovascular Diseases in Paralympic Athletes

“…It is essential to know the phenotypic features that predispose athletes to a better physical performance and more health benefits. There is still large unexplained variability in exercise-induced cardiac remodelling among highly trained endurance athletes, and especially among the disabled athletes [ 9 ]. For this reason, for the first time, the multicentre prospective cohort trial was planned to identify the impact of training load and genotype on the variance of exercise-induced cardiac remodelling [ 9 ].…”

“…There is still large unexplained variability in exercise-induced cardiac remodelling among highly trained endurance athletes, and especially among the disabled athletes [ 9 ]. For this reason, for the first time, the multicentre prospective cohort trial was planned to identify the impact of training load and genotype on the variance of exercise-induced cardiac remodelling [ 9 ]. The study underlines how essential is to determine the association of sport-induced cardiac remodelling with physical performance, health benefits and cardiac pathology.…”

“…One of the most common arrhythmias, atrial fibrillation (AF), has a U-shaped dose–response in relation to endurance exercise [ 9 ]. On the one hand, study from 2008 showed that low-to-moderate-intensity exercise has been related to a decreased risk of atrial fibrillation [ 40 ].…”

Use of Real‐Time Cine MRI to Assess the Respirophasic Variation of the Inferior Vena Cava—Proof‐of‐Concept and Validation Against Transthoracic Echocardiography

“…This study was part of a prospective study looking at the long-term effects of endurance exercise on the heart (Pro@Heart Study-trial registration number NCT05164328-ACTRN126118000716268). 18 The study was approved by the ethical committee (S57241) and all participants gave written informed consent. The study complied with the Declaration of Helsinki.…”

The electrocardiogram in athletes with left ventricular dilatation and reduced ejection fraction

“…The ongoing studies of master@heart and pro@heart aim to comprehensively phenotype, respectively, the older and the younger endurance athlete in prospective, longitudinal cohort studies. 12,13 Similarly, the SMART protocol (Selective Medical Advanced CaRdiovascular Topsports screening) and the coupled ELITE cohort (Evaluation of Lifetime participation in Intensive Top-level sports and Exercise), a collaborative initiative of the Dutch National Olympic Committee and the Dutch Sports Federation (NOC*NSF), the Netherlands Society of Cardiology Sports Section, and several Dutch academic and nonacademic hospitals, prospectively follows Dutch Olympic athletes, during and after their Olympic career. These initiatives include, among others, both extensive phenotyping (including repeated cardiac magnetic resonance imaging) and cardiogenetics.…”