Left ventricular structure and function by echocardiography in ultraendurance athletes

doi:10.1016/0002-9149(86)90358-9

The American Journal of Cardiology

Volume 58, Issue 9, 1 October 1986, Pages 805-809

https://doi.org/10.1016/0002-9149(86)90358-9 Get rights and content

Abstract

To determine left ventricular (LV) structural and functional changes induced by ultraendurance exercise training, M-mode LV echograms and Doppler recordings of LV inflow velocity in 26 triathletes and 17 normal subjects were studied. All triathletes trained 20 to 40 hours/week in swimming, cycling and running for more than 2 years. Structurally, triathletes had normal LV systolic and diastolic cavity dimensions, but increased wall thickness (1.05 ± 0.26 vs 0.80 ± 0.27 cm in normal subjects, p < 0.001), increased relative wall thickness, or h/R ratio (0.41 ± 0.10 cm vs 0.33 ± 0.11 cm in normal subjects, p < 0.001), and increased LV mass (226 ± 60 vs 143 ± 54 g in normal subjects, p < 0.001). LV mass correlated closely with mean exercise blood pressure during an 8-hour exercise test in 14 triathletes (r = 0.88). Systolic function at rest was similar in both groups, with no differences in fractional shortening or end-systolic stress. Diastolic LV function measured by digitized M-mode echo was similar in normal subjects and triathletes, with no differences in peak rates of cavity enlargement and wall thinning by echocardiogram. In contrast, the Doppler-derived ratio of early-to-late LV inflow velocities was slightly increased in triathletes (p < 0.05). It is concluded that ultraendurance training produces a physiologic pattern of moderate pressure overload LV hypertrophy, in proportion to the hemodynamic load imposed during prolonged exercise. Unlike the abnormal hypertrophy of systemic hypertension, early diastolic function remains normal in the triathlete heart.

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However, findings of frank diastolic dysfunction in conjunction with mild concentric LV hypertrophy in the athletes practicing isometric training may indicate early hypertensive heart disease and should be considered in the differential diagnosis. The evaluation of global LV systolic function as measured by the ejection fraction has not proved to be a significant discriminator of exercise-induced functional adaptations from pathologic cardiac disease processes.27-30 However, interrogation of myocardial mechanics with an emphasis on regional deformation patterns may be a useful adjunct in the assessment of grey zone concentric LV hypertrophy.31-34
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Le remodelage cardiaque induit par l’exercice (RCIE) fait référence aux adaptations cardiaques structurelles et fonctionnelles qui se produisent en réponse au stress hémodynamique de l’exercice vigoureux. La différenciation de l’hypertrophie cardiaque physiologique à la suite du RCIE de la pathologie cardiaque structurelle peut être difficile dans la pratique clinique à cause du mélange phénotypique entre les formes extrêmes de « cœurs d’athlètes » et les formes légères de cardiomyopathie. Ce chevauchement phénotypique structurel équivaut à une zone grise d’incertitude clinique. Particulièrement, les athlètes asymptomatiques qui présentent une dilatation extrême du ventricule gauche (VG), un épaississement de la paroi du VG ou une dilatation du ventricule droit (VD) nécessitent une approche diagnostique systématique et intégrée pour parvenir à une différenciation clinique précise. La combinaison de l’anamnèse et de l’examen clinique minutieux, de l’imagerie cardiaque multimodalité utilisée de manière appropriée, de l’épreuve fonctionnelle à l’effort, de la surveillance ambulatoire du rythme cardiaque et du désentraînement occasionnel fournit habituellement les données nécessaires aux fins de diagnostic et les recommandations en matière d’activité physique. Une distinction clinique plus poussée entre les cœurs d’athlètes et la pathologie cardiaque peut ressortir des futurs efforts en recherche clinique et translationnelle établissant les profils et les mécanismes des biomarqueurs associés à l’exercice qui sous-tendent les adaptations du RCIE.
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The impact of exercise training on LV function has also been studied. Resting systolic function, as measured by the echocardiographic LV ejection fraction, has been assessed in athletes by numerous investigators.21-24 These studies and a larger meta-analysis show that LV ejection fraction is generally normal among athletes.25
Early investigations in the late 1890s and early 1900s documented cardiac enlargement in athletes with above-normal exercise capacity and no evidence of cardiovascular disease. Such findings have been reported for more than a century and continue to intrigue scientists and clinicians. It is well recognized that repetitive participation in vigorous physical exercise results in significant changes in myocardial structure and function. This process, termed exercise-induced cardiac remodeling (EICR), is characterized by structural cardiac changes including left ventricular hypertrophy with sport-specific geometry (eccentric vs concentric). Associated alterations in both systolic and diastolic functions are emerging as recognized components of EICR. The increasing popularity of recreational exercise and competitive athletics has led to a growing number of individuals exhibiting these findings in routine clinical practice. This review will provide an overview of EICR in athletes.
Left Ventricular Hypertrophy in Athletes: Morphologic Features and Clinical Correlates
2007, Cardiology Clinics
Citation Excerpt :
Among 235 triathlon participants studied by Douglas and colleagues [12], 43% of females had an absolute LV mass greater than the accepted upper limits of normal (198 g) and only 17% of males had an absolute LV mass that exceeded accepted upper limits of normal (294 g) (Fig. 2). Like other morphologic changes associated with athlete's heart, LV mass thus usually falls within the accepted normal limits for age- and sex-matched control subjects, and LV hypertrophy, if present, is usually mild to moderate at worst [4–15]. In addition, concentric and eccentric remodeling is rare.
The athlete's heart is a constellation of cardiac morphologic changes, including increased left ventricular volume, increased left ventricular mass, increased left atrial volume, and right ventricular structural changes as a physiologic response to exercise training. These structural changes fall within the normal reference ranges of appropriately matched control subjects for most trained individuals; however, there are significant numbers of athletes who have “abnormal” measurements. The ability to distinguish between physiologic changes associated with the athlete's heart and structural abnormalities that may represent underlying cardiac disease is of paramount importance. Structural heart disease significantly increases risk for morbidity, mortality, and sudden death, especially during exercise or physical stress. This article reviews the morphologic changes associated with the athlete's heart.
Electro-echocardiographic correlation in high-performance athletes
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Left ventricular structure and function by echocardiography in ultraendurance athletes

Abstract

Am J Cardiol

Respir Physiol

JACC

Prog Cardiovasc Dis

Am J Cardiol

JACC

JACC

JACC

Am J Cardiol

Am J Cardiol

Effect of training on left ventricular structure and function: an echocardiographic study

Br Heart J

Physiological left ventricular hypertrophy

Br Heart J

Echocardiographic evaluation of long-term effects of exercise on left ventricular hypertrophy and function in professional bicyclists

Circulation

Cardiac hypertrophy and function in master endurance runners and sprinters

J Appl Physiol

Cardiac structure and function in cyclists and runners: comparative echocardiographic study

Br Heart J