Association between left ventricular structure and cardiac performance during effort in two morphological forms of athlete’s heart
Introduction
Athlete’s heart is a left ventricular (LV) adaptation to long-term, intensive training which includes changes such as increased cavity diameter, wall thickness and LV mass [1], [2], [3], [4], [5], produced to a degree consistent with sport activity and exercise programs. Standard Doppler echocardiography has been widely used to identify athlete’s heart and to distinguish it from LV pathologies [1], [2], [3], [4], [5], [6], [7], [8]. Morganroth et al. [1] were the first to postulate that two different morphological forms of athlete’s heart can be distinguished: a strength-trained and an endurance-trained heart. A recent large meta-analysis on this topic confirmed how endurance- and strength-training may determine either extreme volume or pressure load, thus explaining the athlete’s increase in LV internal dimension and/or wall thickness [6].
Even though the morphology of the athlete’s heart and the effects of different sports have been recently investigated by several authors [4], [5], [6], few data are presently available about the possible impact of LV structure at rest on cardiac performance during physical effort [9], [10], [11], [12].
On these grounds, the present study was designed to investigate in 263 competitive athletes the possible association between changes induced by different sport activities on LV structure and cardiac response during maximal physical effort. This issue may be critical to better understand the mechanisms underlying LV supernormal systolic and diastolic function observed in athletes at rest as well as during effort [9], [10], [11], [12].
Section snippets
Study population
After the approval of the Institutional Ethics Committee, 160 top-level endurance-trained athletes (ATE; long distance swimmers, runners) and 103 competitive strength-trained athletes (ATS; weight-lifters, body-builders), both having evidence of left ventricular hypertrophy (LVH) (LV mass index >50 g/m2.7 according to the Cornell criteria [13]), were included into the study after their informed consent was obtained.
Training protocols
All the subjects had been training intensively for 15–20 h/week for >4 years.
Clinical characteristics of the study population
As expected, ATS at rest showed higher HR, BSA and systolic BP than ATE (Table 1).
Standard Doppler echocardiographic analysis
LV mass index and fractional shortening did not significantly differ between the two groups (Table 2). However, ATS showed increased sum of wall thickness (septum+LV posterior wall), LV ESSc and relative wall thickness, while LV stroke volume and LV end-diastolic diameter were greater in ATE. All transmitral Doppler indexes were higher in ATE, with increased E/A ratio.
Reproducibility of echocardiographic measurements
Interobserver variability was ±2.6% for septal
Discussion
This study emphasizes the association existing between LV structure at rest and cardiac performance during physical effort in athletes undergoing different long-term intensive training protocols. Our findings suggest that, in the absence of differences in LVMI, (i) ATE achieved greater maximal workload with lower rate-pressure product than ATS; (ii) ATS showed higher values of SBP both at rest and during physical effort; (iii) ATE showed by heart rate variability analysis higher parasympathetic
Acknowledgements
This research is supported by Ph. Doctorate in Medical-Surgical Physiopathology of Cardiopulmonary and Respiratory System and Associated Biotechnologies–SUN. The authors are indebted to Mrs. Anna Gaglione for excellent nursing and technical support during the study protocol.
References (29)
- et al.
Morphology of the ‘athlete’s heart’ assessed by echocardiography in 947 elite athletes representing 27 sports
Am J Cardiol
(1994) - et al.
Pulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and myocardial regional diastolic function
Am J Cardiol
(2000) - et al.
Different effects of prolonged exercise on the right and left ventricles
J Am Coll Cardiol
(1990) - et al.
Assessment of myocardial response to physical exercise in endurance competitive athletes by pulsed Doppler tissue imaging
Am J Cardiol
(2001) - et al.
Comparison of left ventricular function using isometric exercise Doppler echocardiography in competitive runners and weightlifters versus sedentary individuals
Am J Cardiol
(1997) - et al.
Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight
J Am Coll Cardiol
(1992) - et al.
Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination
Am Heart J
(1990) - et al.
Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study
J Am Coll Cardiol
(1988) - et al.
Determinants of Doppler indices of diastolic function in normal subjects (the Framingham Heart Study)
Am J Cardiol
(1992) - et al.
Impact of heart rate and PR interval on Doppler indexes of diastolic filling in an elderly cohort (the Framingham Heart Study)
Am J Cardiol
(1993)
Rapid changes in left ventricular dimensions and mass in response to physical deconditioning
Am J Coll
Comparative left ventricular dimension in trained athletes
Ann Intern Med
The athletic heart syndrome
N Engl J Med
Outer limits of the athlete’s heart: the effect of gender and relevance to the differential diagnosis with primary cardiac diseases
Cardiol Clin
Cited by (118)
Evaluation of Left Ventricular Systolic Function Using Layer-Specific Strain in Rats Performing Endurance Exercise: A Pilot Study
2023, Ultrasound in Medicine and BiologyEchocardiogram in athlete’s heart
2023, Athlete's Heart: A Multimodal Approach - From Physiological to Pathological Cardiac AdaptationsElectrocardiogram in athletes
2023, Athlete's Heart: A Multimodal Approach - From Physiological to Pathological Cardiac AdaptationsRecommendations on the Use of Multimodality Cardiovascular Imaging in Young Adult Competitive Athletes: A Report from the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Computed Tomography and the Society for Cardiovascular Magnetic Resonance
2020, Journal of the American Society of EchocardiographyAthlete’s Heart: A Cardiovascular Step-By-Step Multimodality Approach
2023, Reviews in Cardiovascular Medicine