Right and left ventricular diastolic function of male endurance athletes

https://doi.org/10.1016/j.ijcard.2003.07.008Get rights and content

Abstract

Background: Echocardiography of endurance athletes has demonstrated a substantial increase in left ventricular mass with no disturbance of diastolic function as assessed by the e:a ratio. Few studies have examined the right ventricle of athletes. The present study evaluated diastolic function of both right and left ventricles of endurance athletes through use of measurements of the motion of the atrioventricular (AV) plane. Methods: Endurance athletes (runners) and sedentary subjects were studied. All subjects were male, aged 30–45 years and were free of cardiovascular disease. There were 21 runners and 40 sedentary subjects. The diastolic motion of the AV plane was assessed by measurement of total displacement and peak early velocity. Results: The runners had a greater peak oxygen consumption (ml kg−1 min−1) (59.5 vs. 33.5, P<10−3) and left ventricular mass (g) (281 vs. 202, P<10−3). The e:a ratio for both groups was similar (1.41 vs. 1.45, P=0.8). Both total displacement and peak early velocity for both ventricles were similar between groups, P>0.3. No correlation with age was found for total displacement or peak early velocity for either group in either ventricle, with the exception of peak early velocity for the right ventricle in the runners, where a highly significant correlation was found: peak early velocity=24.0−0.4 age, r2=0.75, P=10−5. Conclusion: Chronic endurance training is associated with a greater LV mass than in comparable sedentary subjects. Despite this, no effect on AV plane motion was found. A decline in right ventricular peak early velocity of the AV plane with increasing age was identified in the runners. This was an unexpected finding and requires further study.

Introduction

Chronic endurance training results in an increase in left ventricular mass (physiological hypertrophy) as compared with sedentary subjects. Pathological hypertrophy is associated with abnormal left ventricular diastolic function, as assessed by the e:a ratio [1], [2]. A meta analysis including 413 runners found no disturbance of the e:a ratio in runners [3]. Thus it is believed that the substantial increase in left ventricular mass associated with endurance training does not adversely affect left ventricular diastolic function. The e:a ratio, however, is a very crude tool with which to assess diastolic function. Consequently, it is possible that subtle differences in diastolic function could exist and not be identifiable by the use of the e:a ratio. For example, after 18 weeks of brisk walking, previously sedentary subjects showed an improvement in peak early velocity of the left ventricular atrioventricular (AV) plane but no change in the e:a ratio was seen [4].

The aim of the present study was to investigate right ventricular and left ventricular diastolic function of endurance athletes (runners) through use of measurements of motion of the AV plane. Specifically we wished to determine if the much greater level of physical activity undertaken by runners was associated with a larger effect on peak early velocity at the left free wall.

Section snippets

Methods

Male runners and male sedentary subjects aged 30–45 years were recruited. The runners were recruited from local running clubs and were a subset of a group described elsewhere [5]. To be eligible subjects had a 10 km race speed of at least 65% of the best ever US speed [6] for their age group in the previous 6 months. Sedentary subjects were recruited via notice board advertisements within the university, and should not have been engaged in vigorous activities (e.g. swimming, jogging or fitness

Statistical analysis

We have previously shown that sedentary subjects who participate in an 18-week brisk walking regime have a mean increase in peak early velocity at the left free wall of 1.2 cm s−1 [4]. The aim of the present study was to determine if the much greater level of physical activity undertaken by runners was associated with a larger effect on peak early velocity at the left free wall. Conversely we could not exclude the possibility that the substantial increase in left ventricular mass associated

Results

Table 1 gives the anthropometric and physiological data for the two groups. The age and height are similar whereas substantial differences are apparent for peak oxygen consumption, heart rate and mass.

The M-mode and Doppler measurements are shown in Table 2. There are modest differences in left ventricular dimensions which result in a substantially greater left ventricular mass for the runners compared with the sedentary subjects. The left ventricular filling velocities for both groups are

Discussion

This study has examined diastolic function (AV plane motion) of endurance athletes (runners) and comparable sedentary subjects. The study recruited a total of 61 subjects but fewer runners than anticipated. This gives the same power as a sample size of 54 with equal numbers in each group. Thus the power of the study has not been compromised by the imbalance in recruitment.

The median age of runners recruited at 40 years was somewhat older than in many previous studies. Indeed of the studies

References (11)

There are more references available in the full text version of this article.

Cited by (12)

  • Patterns of left ventricular diastolic function in olympic athletes

    2015, Journal of the American Society of Echocardiography
    Citation Excerpt :

    Another possible explanation for this phenomenon is the hypothesis that under resting condition, the untwisting of the left ventricle occurs at a lower velocity (as also demonstrated by an increased IVRT), with a consequently slower decay in LV pressure needed to generate the suction forces40; however, the untwisting forces may become more relevant during exercise and at higher heart rates to generate more efficient filling of the left ventricle.41 Our results are partially different from those of previous studies, which are largely heterogeneous: the E/A ratio was reported to be unchanged by some authors42,43 but increased by others16,37; certain studies reported increased E-wave velocity,20,37 whereas most the others showed that it was unchanged14,36,37; and e′ velocity was increased in some studies18,37,43 and unchanged in others.14,16,36 These marked differences are likely due to the restricted and selected athlete populations included in previous studies, which do not allow a complete picture of diastolic function in athletes.

  • Sedentary, active and athletic lifestyles: Right and left ventricular long axis diastolic function

    2008, International Journal of Cardiology

  • Reply to "a difficult puzzle: Right ventricular remodeling in athletes"

    2005, International Journal of Cardiology

  • A difficult puzzle: Right ventricular remodeling in athletes

    2005, International Journal of Cardiology

  • Functional and Morphological Adaptations in the Heart of Children Aged 12–14 Years following Two Different Endurance Training Protocols

    2023, Sports

  • Doppler echocardiography in athletes from different sports

    2013, Medical Science Monitor
View all citing articles on Scopus
1

Present address: Centre for Population Health in the West, Sunshine Hospital, Victoria, Melbourne, Australia.

View full text
Copyright © 2003 Elsevier Ireland Ltd. All rights reserved.