Echocardiographic findings in 104 professional cyclists with follow-up study

doi:10.1016/0002-8703(94)90559-2

American Heart Journal

Volume 127, Issue 4, Part 1, April 1994, Pages 898-905

https://doi.org/10.1016/0002-8703(94)90559-2 Get rights and content

Abstract

To assess the effect of long-term athletic training on the heart, 104 professional cyclists and 40 sedentary controls (69 younger cyclists and 26 controls aged 20 to 39 and 35 older cyclists and 14 controls aged 40 to 60) were examined by using M-mode and pulsed Doppler echocardiography. Cyclists had larger and more hypertrophied left ventricle than did controls (p < 0.001) and had normal percentages of fractional shortening (%FS). The ratio of left ventricular late-to-early diastolic peak filling velocity ( $A R$ ) of younger cyclists was normal, but the $A R$ of older cyclists was larger than that of controls (p < 0.001). Of the 104 cyclists, 95 continued cycling and were reexamined 2 years later; 9 of 40 older cyclists retired and were reexamined 20 ± 8 months after retirement. During the follow-up period for the active cyclists, left ventricular dilatation, hypertrophy, and %FS of both younger and older cyclists and the $A R$ of younger cyclists did not change. However, the $A R$ of older cyclists increased (p < 0.01). For the nine retired cyclists, left ventricular dimension decreased (p < 0.001), left ventricular wall thickness and %FS did not change, and $A R$ increased (p < 0.05) after retirement. We concluded that (1) cyclists had large and hypertrophied left ventricles with normal systolic function, and (2) some cyclists with long-term athletic training may have partly irreversible left ventricular hypertrophy with impaired left ventricular diastolic filling.

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Cited by (31)

Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis
2020, Progress in Cardiovascular Diseases
Citation Excerpt :
From the 4865 unique studies identified during the literature search, 70 studies met the inclusion criteria for review (Fig. 1) and data were extracted from 25 studies28,38,47–69 for analysis (Table 1). Of these, 18 studies28,38,48,49,52–54,56–66 compared cyclists to control and 10 studies28,47–55 compared cyclists to athletes participating in other sports, with cardiac outcomes reported in units relative to body size for meta-analysis. Seventeen studies were not included in the meta-analysis as they: potentially included the same participants as other included studies,36,37,70 presented control values from a clinical population71,72 or another study from which the data were being used,73–75 evaluated cyclists who were retired67,69,76 or presented no outcomes in units relative to body size.35,68,69,77–81
To compare heart structure and function in endurance athletes relative to participants of other sports and non-athletic controls in units relative to body size. A secondary objective was to assess the association between endurance cycling and cardiac abnormalities.
Five electronic databases (CINAHL, Cochrane Library, Medline, Scopus, and SPORTdiscus) were searched from the earliest record to 14 December 2019 to identify studies investigating cardiovascular structure and function in cyclists. Of the 4865 unique articles identified, 70 met inclusion criteria and of these, 22 articles presented 10 cardiovascular parameters in units relative to body size for meta-analysis and five presented data relating to incidence of cardiac abnormalities. Qualitative analysis was performed on remaining data. The overall quality of evidence was assessed using GRADE. Odds ratios were calculated to compare the incidence of cardiac abnormality.
Heart structure was significantly larger in cyclists compared to non-athletic controls for left ventricular: mass; end-diastolic volume, interventricular septal diameter and internal diameter; posterior wall thickness, and end-systolic internal diameter. Compared to high static and high dynamic sports (e.g., kayaking and canoeing), low-to-moderate static and moderate-to-high dynamic sports (e.g., running and swimming) and moderate-to-high static and low-to-moderate dynamic sports (e.g., bodybuilding and wrestling), endurance cyclists end-diastolic left ventricular internal diameter was consistently larger (mean difference 1.2–3.2 mm/m²). Cardiac abnormalities were higher in cyclists compared to controls (odds ratio: 1.5, 95%CI 1.2–1.8), but the types of cardiac abnormalities in cyclists were not different to other athletes.
Endurance cycling is associated with a larger heart relative to body size and an increased incidence of cardiac abnormalities relative to controls.
Serum collagen-derived peptides are unaffected by physical training in older sedentary subjects
2010, Journal of Science and Medicine in Sport
Citation Excerpt :
By contrast, in veteran elite endurance athletes (mean age 52 years) who were running at least 30 miles/week, echocardiographic evidence of LVH and elevations in the serum markers PICP and ICTP of collagen synthesis and degradation were documented in comparison with a matched cohort of normal sedentary subjects, suggesting the presence of cardiac fibrosis related to long-term high-intensity endurance activity.13 The fact that most veteran athletes often do not experience complete regression of ventricular hypertrophy upon cessation of physical training suggest a mechanism other than pure myocyte hypertrophy.12 In 19-year-old subjects, a 4-month military recruit combat training program increased the serum PINP and CITP level significantly within 2 months, independent of gender or maximal oxygen uptake, indicating a rapid onset of collagen turnover on strenuous exercise.28
Cardiac fibrosis occurs with normal aging and may have important pathological consequences. Accumulating evidence shows that biochemical assessment of fibrosis using collagen markers such as serum levels of the aminoterminal propeptide of types I and III collagen (PINP, PIIINP) and the carboxyterminal telopeptide of type I collagen (ICTP) represents a practical, validated and non-invasive method to assess myocardial collagen turnover. It is generally accepted that a sedentary lifestyle may be at least partly responsible for the age-related changes in the cardiovascular system. We aimed to investigate whether dynamic aerobic endurance training at lower or higher intensity (33% and 66% of heart rate reserve) may influence markers of collagen synthesis (PINP, PIIINP) and degradation (ICTP) in at least 55-year-old healthy sedentary men and women. A randomised crossover study comprising three 10-week periods was performed. In the first and third period, participants exercised at, respectively, lower or higher intensity in random order, with a sedentary period in between. Training programs were identical except for intensity and were performed three times 50 min/week. 39 (18 men) out of 48 randomised participants completed the study; age averaged 59 years. Serum concentrations of PINP, PIIINP and ICTP were determined at baseline and at the end of each 10-week period. Our results showed that 10 weeks of endurance training at lower or higher intensity did not significantly alter serum markers of collagen synthesis and degradation in healthy older men and women.
Left ventricular hypertrophy in Caucasian master athletes: Differences with hypertension and hypertrophic cardiomyopathy
2006, International Journal of Cardiology
To study, by conventional echocardiography, left ventricular remodelling and function in master athletes, hypertension and hypertrophic cardiomyopathy.
We studied 30 master athletes (MA; soccer players; mean age 43.9 ± 5.9), 24 subjects with essential hypertension (HYP; 46.6 ± 6), 20 patients with hypertrophic cardiomyopathy (HCM; 42.2 ± 9) and 30 normal individuals (CG; 43.4 ± 5). An integrated M-mode/two-dimensional echocardiographic analysis was performed to determine chambers dimensions, relative wall thickness (RWT) and left ventricular mass (LVM), indexed to height in meters raised to the power of 2.7 (LVM/h^2.7). Cut-off levels for LVM/h^2.7 and RWT were defined to assess 4 different patterns of LV geometric remodelling. In addition, we measured indexes of global systolic performance and indexes of global diastolic function.
LV wall thickness and LV end-diastolic dimensions were higher in MA than controls, but significantly lower than other groups. LVH/h^2.7 was increased in 79% of HYP and in 95% of HCM, but was within the normal limits in MA. LV geometry was normal in 22 out of 30 MA (73%), while the remaining (8 athletes, 27%) showed a concentric remodelling. Systolic function (FS and EF) was normal in MA, but was slightly reduced in HYP and increased in HCM. Analysis of diastolic function showed an abnormal relaxation pattern in all HYP and 95% of HCM, but was normal in all MA. The ratio between peak filling rate and stroke volume (PFR / SV), a relatively independent index of diastolic function, was significantly greater in hypertensive patients with normal LV remodelling compared to those without it (4 ± 0.39 vs. 4.91 ± 0.19; P = 0.0002).
MA showed lower values of wall thickness, LV dimensions and LV mass compared with HYP and HCM. Despite an abnormal remodelling, all the athletes showed a normal systolic and diastolic function. The differential diagnosis between MA, HYP and HCM is feasible by accurate, comprehensive standard Doppler echocardiography.
Effects of 16 weeks of resistance training on left ventricular morphology and systolic function in healthy men >60 years of age
2000, American Journal of Cardiology
Citation Excerpt :
A series of studies have found that 3 to 9 months of endurance training was not associated with changes in LV diastolic cavity dimension,14–16 posterior wall thickness,14–19 ventricular septal wall thickness,14–19 or estimated LV mass15,16 in previously sedentary middle-aged or older adults. Contrary to the above findings, other studies have found that the ability of the human heart to alter its size was not diminished with age because master endurance athletes were found to have a larger LV diastolic cavity dimension,20–22 ventricular septal wall thickness,21,23,24 posterior wall thickness,21–24 relative wall thickness,20 and LV mass20–24 than age-matched sedentary subjects or sport-matched younger athletes. However, to attain the increased LV dimensions and mass, master athletes had to train for an extremely long time (i.e., 3 to 6 decades).20,22–24
Resistance training (RT) has gained popularity as an effective form of exercise for older adults. However, the effects of RT on left ventricular (LV) morphology and systolic function in older persons is not well known. The purpose of this study was to assess the effects of 16 weeks of RT on LV morphology and systolic function in healthy older men. Subjects were randomly assigned into a RT group (n = 10; mean ± SD age, 68 ± 3 years) or a nonexercise control group (n = 10; age 68 ± 4 years). RT was performed 3 times per week for 16 weeks at a mean intensity between 60% and 80% of 1 repetition maximum. Leg and bench press 1 repetition maximum and 2-dimensional echocardiography were performed at baseline and after 4, 8, 12, and 16 weeks of training in the RT group. Sixteen weeks of RT was associated with an increase in leg press maximal strength (baseline, 285 ± 48 kg; after 16 weeks, 367 ± 47 kg; p <0.05) and bench press maximal strength (baseline, 59 ± 11 kg; after 16 weeks, 69 ± 11 kg; p <0.05). No change in leg press maximal strength (baseline, 291 ± 59 kg; after 16 weeks, 290 ± 53 kg; p >0.05) or bench press maximal strength (baseline, 60 ± 9 kg; after 16 weeks, 61 ± 13 kg; p >0.05) was found in control subjects during the same time. RT was not associated with changes in LV cavity size, wall thickness, mass, or systolic function after 4, 8, 12, and 16 weeks of exercise. Thus, 16 weeks of RT was sufficient to increase leg press and bench press maximal strength but did not alter the size or systolic function of the senescent left ventricle.
Cardiovascular adaptations to endurance training and detraining in young and older athletes
1998, International Journal of Cardiology
In order to evaluate the influence of aging on cardiovascular adaptations to endurance training and detraining, 12 young (range 19–25 years) and 12 older (range 50–65 years) male cyclists were examined during the training and after 2 months of detraining. Twelve young and 12 older healthy sedentary males matched for age and body surface area were used as control groups. Each subject underwent a maximal exercise test using a cycle-ergometer in order to measure maximum oxygen consumption, an M-mode and 2D echocardiography in order to assess left ventricle morphology and systolic function, and a Doppler echocardiography for evaluating the diastolic filling pattern. During the training period both groups of athletes showed higher values of maximum oxygen consumption, left ventricular wall thicknesses, end-diastolic diameter and volume, as well as left ventricular mass, than their control subjects; in the older subjects the adaptation of the heart to aerobic training seems to be obtained mainly through a higher increase in left ventricular diastolic filling. In both groups no significant modifications in the ejection fraction and diastolic function parameters were recorded. After the detraining period the wall thicknesses decreased only in young athletes, while left ventricular mass and end-diastolic diameter and volume reduced only in older athletes. In conclusion, training and detraining induced nearly similar left ventricular morphological modifications in the two age groups, even though greater in the older athletes with respect to the ventricular mass and volume. No relevant differences were observed in the Doppler filling pattern between athletes and sedentary controls.
Evaluation of left ventricular diastolic function by pulmonary venous and mitral flow velocity patterns in endurance veteran athletes
1996, Archives of Gerontology and Geriatrics
More and more older people exercise endurance training. Physical activity regularly exercised has been proven to exert beneficial effects on the cardiovascular system. The aim of the present study was to investigate left ventricular diastolic function by analysis of the pulmonary venous flow velocity pattern (PVFVP) in conjunction with the mitral flow velocity pattern (MFVP) in endurance veteran athletes. The study was performed in 15 trained veteran athletes (mean age 60 ± 10) and 15 sedentary older subjects (mean age 61 ± 7). Between the two groups there were no differences of age, body surface area and blood pressure. All subjects were without evidence of cardiovascular diseases. They underwent transthoracal pulsed Doppler echocardiography and the following parameters were measured: early (E) and late (A) peak diastolic filling velocities from mitral flow and E/A ratio; peak forward flow velocities during systole (S) and diastole (D) and peak reverse flow velocity at atrial contraction (Ar) from right upper pulmonary vein. The peak early diastolic filling and E/A ratio resulted significantly increased in the veteran athletes compared with the older sedentary subjects (E 80.0 ± 13.6 and 62.2 ± 8.2, respectively, p < 0.01; E/A 1.20 ± 0.1 and 0.90 ± 0.1, respectively, p < 0.001), whereas there were no significant differences m the PVFVP between the two groups. Heart rate at rest was significantly lower in the veteran athletes compared with sedentary older subjects (58.3 ± 8 and 72.8 ± 7.6, respectively, p < 0.001). These data demonstrate an improvement of left ventricle diastolic function in endurance veteran athletes (E/A ratio > 1 ) in comparison with sedentary older subjects (E/A ratio > 1). Analysis of PVFVP suggests that the left atrial contribution to left ventricular filling increases with aging without any significant differences between the two groups. Therefore, left atrial function, i.e., the main determinant of PVFVP is not likely influenced by training. In conclusion, physical activity was found to attenuate alterations in the cardiovascular system that occur in advanced age by an improvement of left ventricular diastolic filling. These changes at rest may be due to a decreased sympathetic tone, as well as to an improvement of intrinsic properties of myocardium of the endurance veteran athletes.

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Echocardiographic findings in 104 professional cyclists with follow-up study

Abstract

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Am J Cardiol

Comparative left ventricular dimensions in trained athletes

Ann Intern Med

Echocardiographic assessment of cardiac chamber size and left ventricular function in aerobically trained athletes

Aust NZ J Med

Non-invasive evaluation of cardiac function in professional cyclists

Br Heart J