RETRACTED ARTICLE: The upper limit of physiological cardiac hypertrophy in elite male and female athletes in China

Sun, Bo; Zheng, Ji; Yong, Yong Hong; Lv, Yuan Yuan

doi:10.1007/s00421-007-0517-5

Cited by 29 publications

(30 citation statements)

References 35 publications

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“…There was no significant influence of age on the ventricular mass or on the ventricular volume in the multivariate model. As in other studies,18 28 29 male gender resulted in more pronounced increase of LV EDV and LV EDM, regardless of BSA.…”

Section: Discussionsupporting

confidence: 85%

Sport category is an important determinant of cardiac adaptation: an MRI study

et al. 2012

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Section: Discussionsupporting

confidence: 85%

Sport category is an important determinant of cardiac adaptation: an MRI study

et al. 2012

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“…A study by Sun et al in elite Chinese athletes from a variety of sporting disciplines demonstrated that Chinese athletes exhibit LV cavity size dilatation and associated LVH of similar magnitude to Caucasian athletes 35. Of the 165 male athletes, 11.5% exhibited a LV cavity size >60 mm with a maximum diameter of 65 mm and only 3 (1.8%) athletes exhibited a wall thickness of >12 mm.…”

Section: Impact Of Ethnicity Upon Cardiovascacular Adaptation To Exermentioning

confidence: 98%

Impact of ethnicity upon cardiovascular adaptation in competitive athletes: relevance to preparticipation screening

et al. 2012

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Regular participation in intensive physical exercise is associated with several structural and electrophysiological cardiac adaptations that enhance diastolic filling and facilitate a sustained increase in the cardiac output that is fundamental to athletic excellence. Such cardiac adaptations are collectively referred to as the ‘Athlete's Heart’ and are frequently reflected on the 12-lead ECG and imaging studies. Thorough knowledge relating to exercise-associated cardiovascular adaptation is imperative for the purposes of differentiating physiological adaptation from cardiac pathology, since an erroneous diagnosis of cardiac disease has potentially serious consequences for the athlete's physical, psychological, social and financial well-being. The majority of studies investigating the cardiovascular adaptation to exercise are based on cohorts of Caucasian athletes. However, there is mounting evidence that ethnicity is an important determinant of the objective manifestations of cardiovascular adaptation to exercise. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from athletes of African/Afro-Caribbean descent, who exhibit a significantly higher prevalence of repolarisation anomalies and left ventricular hypertrophy, compared to Caucasian athletes; the differentiation between athlete's heart and hypertrophic cardiomyopathy is particularly challenging in this ethnic group. The extrapolation of ECG and echocardiographic criteria used to diagnose potentially serious cardiac disorders in Caucasian athletes to the African/Afro-Caribbean athlete population would result in an unacceptable number of unnecessary investigations and increased risk of false disqualification from competitive sport. Accurate interpretation of the athlete's ECG and echocardiogram is crucial, particularly when one considers the continuous expansion of preparticipation screening programmes. This review attempts to highlight ethnically determined differences in cardiovascular adaptation to exercise and provides a practical guide for the interpretation of baseline investigations in athletes of diverse ethnic backgrounds.

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“…Some data on left ventricular (LV) M-mode measurements are available, 10,12,14,17,20,23,24,28,30,31,35,36–38 while data for all the other specific structures are limited (e.g. left atrial (LA) area and volumes, right ventricular (RV) diameters, aorta) or rare (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…10,14 Numerical limitations included limited sample size (e.g. < 450 subjects) in some studies 12,28,30,31,34 and limited structures evaluated in others. 11,18–20,24,25,28,30,31 Theoretically, the sample size needed to build a nomogram should be calculated by dividing the population into age groups and assuming a minimum number (at least 80 and ideally 120 subjects) for each of the groups.…”

Section: Resultsmentioning

confidence: 99%

“…3–6 However, nomograms calculated in the general population cannot be applied to athletes, a setting in which the cardiac dimensions are physiologically increased. 8–40 Great advances have been made in screening athletes' hearts based on ECG findings, 41 and basic criteria have been established, 41 while echocardiographic criteria are less well defined. Thus, in recent years, echocardiographic nomograms specific for athletes have been proposed.…”

Section: Introductionmentioning

confidence: 99%

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Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review

Cantinotti

Koestenberger

Santoro

et al. 2019

Eur J Prev Cardiolog

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In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms. The search was refined by adding the keywords heart, sport, elite, master, children and young. Twenty-eight studies were selected for the final analysis. Our research revealed that currently available ranges of normality for athletes reported by different authors are quite consistent, with limited exceptions (e.g. atria, aorta). Numerical and methodological limitations, however, emerged. Numerical limitations included a limited sample size (e.g. < 450 subjects) of the population assessed and the paucity of data in women, non-Caucasian athletes, and junior and master athletes. Some data on M-mode measurements are available, while those for some specific structures (e.g. left atrial (LA) area and volumes, right ventricular diameters and aorta) are limited or rare (e.g. LA area). There was heterogeneity in data normalization (by gender, sport type and ethnicity) and their expression was limited to mean values ( Z-scores have rarely been employed), while variability analysis was often lacking or incomplete. We conclude that comprehensive nomograms using an appropriate sample size, evaluating a complete dataset of 2D (and three-dimensional) measures and built using a rigorous statistical approach are warranted.

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RETRACTED ARTICLE: The upper limit of physiological cardiac hypertrophy in elite male and female athletes in China

Cited by 29 publications

References 35 publications

Sport category is an important determinant of cardiac adaptation: an MRI study

Sport category is an important determinant of cardiac adaptation: an MRI study

Impact of ethnicity upon cardiovascular adaptation in competitive athletes: relevance to preparticipation screening

Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review

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