Right and Left Ventricular Function and Mass in Male Elite Master Athletes

Bohm, Philipp; Schneider, Günther; Linneweber, Lutz; Rentzsch, Axel; Krämer, Nadine; Abdul‐Khaliq, Hashim; Kindermann, Wilfried; Meyer, Tim; Scharhag, Jürgen

doi:10.1161/circulationaha.115.020975

Cited by 118 publications

(37 citation statements)

References 35 publications

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“…11 In contrast, Franzen et al demonstrated that LGE was absent in 20 men triathletes and 20 men middle-aged marathon runners. 32 Similarly, in a recent study of 33 elite male athletes and matched control subjects, with a median age of 47 years, only 1 athlete had LGE ‘localized subepicardial in the LV posteroinferior region.’ 33 The present study extends these findings by demonstrating a lack of association of focal myocardial necrosis across a significantly older population with longer physical activity histories and encompassing a spectrum of lifelong physical activity histories.…”

Section: Discussionsupporting

confidence: 72%

Lifelong Physical Activity Regardless of Dose Is Not Associated With Myocardial Fibrosis

Abdullah

Barkley

Bhella

et al. 2016

Circ: Cardiovascular Imaging

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Background Recent reports have suggested that long term intensive physical training may be associated with adverse cardiovascular effects, including the development of myocardial fibrosis. However, the dose-response association of different levels of lifelong physical activity on myocardial fibrosis has not been evaluated. Methods and Results Seniors free of major chronic illnesses were recruited from predefined populations based on the consistent documentation of stable physical activity over >25 years and were classified into 4 groups by the number of sessions/week of aerobic activities ≥ 30 minutes: Sedentary (Group 1) , < 2 sessions; Casual (Group 2), 2-3 sessions; Committed (Group 3), 4-5 sessions; and Masters athletes (Group 4), 6-7 sessions plus regular competitions. All subjects underwent cardiopulmonary exercise testing and cardiac magnetic resonance imaging (cMRI), including late gadolinium enhancement (LGE) assessment of fibrosis. Ninety-two subjects (mean age 69 years, 27% women) were enrolled. No significant differences in age or sex were seen between groups. Median peak oxygen uptake was 25 ml/kg/min, 26 ml/kg/min, 32 ml/kg/min, and 40 ml/kg/min for Groups 1, 2, 3, and 4, respectively. Cardiac MRI demonstrated increasing left ventricular end diastolic volumes, end systolic volumes, stroke volumes, and masses with increasing doses of lifelong physical activity. One subject in Group 2 had LGE, in a non-coronary distribution, and no subjects in groups 3 and 4 had evidence of LGE. Conclusions A lifelong history of consistent physical activity, regardless of “dose” ranging from sedentary to competitive marathon running, was not associated with the development of focal myocardial fibrosis.

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Section: Discussionsupporting

confidence: 72%

Lifelong Physical Activity Regardless of Dose Is Not Associated With Myocardial Fibrosis

Abdullah

Barkley

Bhella

et al. 2016

Circ: Cardiovascular Imaging

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“…In elite athletes, the right ventricular end‐diastolic volume is increased compared with the LV end‐diastolic volume, and a bulge is noted on the RV free wall. Neither of these findings were seen in normal controls . As a result, a complete evaluation of the RV also needs to take into consideration outside factors other than just inherent contractility.…”

Section: Function Of the Rvmentioning

confidence: 97%

“…Neither of these findings were seen in normal controls. 5 As a result, a complete evaluation of the RV also needs to take into consideration outside factors other than just inherent contractility.…”

Section: Function Of the Rvmentioning

confidence: 99%

Echocardiographic evaluation of the right ventricle: Clinical implications

Dutta

Aronow

2017

Clinical Cardiology

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Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a corresponding increase in the ability to evaluate the RV, both qualitatively and quantitatively. Older echocardiographic techniques, such as right ventricular fractional area of change, tricuspid annular plane systolic excursion, and tissue S 0 , and newer echocardiographic techniques including 3-dimensional evaluation and global longitudinal strain, can improve our evaluation of RV function. These techniques provide both diagnostic and prognostic data on a large variety of clinical diseases including pulmonary hypertension and congestive heart failure. With the continuing and exponential advances in technology, echocardiography is well poised to become the primary modality to evaluate the RV. | ANATOMY OF THE RVThe RV is composed of 3 different segments: the inlet area, the trabecular portion, and the outflow area. The inlet extends from the papillary muscles to the tricuspid annulus. The trabecular portion extends from the papillary muscles to the right ventricular (RV) apex.The outflow portion is a smooth area leading to the pulmonic valve. 1Because the RV does not follow a traditional symmetrical shape, the RV volume does not lend itself to estimation. Wall-motion abnormalities are also more difficult to evaluate, as there are 3 different subsections. Wall motion is also difficult to evaluate due to a combination of radial, longitudinal, and circumferential shortening; these independent movements are not clearly visible on an echocardiogram. 2Normal values for the RV were significantly limited due to the lack of standardization across echocardiographic protocols. cMRI, which measures the RV in planes that are not visualized on echocardiography, was able to provide a series of normal valves. As a result, we know that although RV mass and volumes are larger among males vs females, there is no significant difference in systolic function. | FUNCTION OF THE RVThe LV is often described as a pump whose function is based on its inherent contractility. In contrast, the RV is profoundly affected by loading conditions. The RV function is dependent on preload and afterload.2 It provides the same stroke volume as the LV with

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“…The subjects were studied by cardiopulmonary exercise test, 2D, TDI and Strain echocardiography to assess LV and RV morphology and function, and by contrast enhanced cardiac magnetic resonance. In the final results, although the athletes showed LV and RV enlargement in presence of normal biventricular function, a pathological late enhancement was detected in only one athlete, confirming how LV and RV dilation represents physiological remodeling and is not associated with ventricular dysfunction or risk of arrhythmias (Bohm et al, 2016). The contradictory results of published studies are principally due to the fact that neither the type of athletes (kind of sports, training history, period of evaluation) studied nor the methods used were homogenous, in particular for the differences in strain software analysis.…”

Section: Discussionmentioning

confidence: 63%

Enhanced Right-Chamber Remodeling in Endurance Ultra-Trail Athletes Compared to Marathon Runners Detected by Standard and Speckle-Tracking Echocardiography

Ujka¹,

Bastiani²,

D’Angelo³

et al. 2017

Front. Physiol.

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Background: Strenuous and endurance exercise training have been associated with morphological and functional heart remodeling. Two-dimensional speckle-tracking echocardiography (STE) is a novel technique that allows an accurate quantification of global myocardium deformation. Our aim was to evaluate together left and right cardiac remodeling in different long-distance running athletes: marathon runners (42 km) (M) and endurance mountain runners (>300 Km) (UT).Methods: A total of 92 athletes (70 males, 76%) including 47 M [age 45 ± 7 years; training: 18 (9–53) years*days/week], 45 UT [age 42 ± 9, training: 30 (15–66) years*days/week] underwent conventional echocardiography and STE (Beyond Diogenes 2.0, AMID) during the agonistic season.Results: Right ventricle (RV) end-diastolic area (p = 0.026), fractional area changing (FAC) (p = 0.008) and RV global longitudinal strain (GLS) were significantly increasedin UT athletes. Furthermore, UT showed larger right atrium (RA) volume (p = 0.03), reduced RA GLS and significantly increased RA global circumferential strain (GCS) compared to M. After adjustment for age, sex, and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856–0.961) and increased RV FAC (OR 1.172; CI: 1.044–1.317) compared to M.Conclusion: Athletes enrolled in UT endurance activities showed RV and RA morphological and functional remodeling to increased preload in comparison with M runners characterized by increased RV FAC and reduced RA GLS. Follow-up studies are needed to better assess the long-term clinical impact of these modifications. 2D STE is a useful tool for investigating the deformation dynamic in different sports specialties.

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Right and Left Ventricular Function and Mass in Male Elite Master Athletes

Cited by 118 publications

References 35 publications

Lifelong Physical Activity Regardless of Dose Is Not Associated With Myocardial Fibrosis

Lifelong Physical Activity Regardless of Dose Is Not Associated With Myocardial Fibrosis

Echocardiographic evaluation of the right ventricle: Clinical implications

Enhanced Right-Chamber Remodeling in Endurance Ultra-Trail Athletes Compared to Marathon Runners Detected by Standard and Speckle-Tracking Echocardiography

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