Coronary arteries in physiological hypertrophy: echocardiographic evidence of increased proximal size in elite athletes

One hundred and twenty-five healthy, male top-level athletes were evaluated by echocardiography (Echo) and assigned to six groups according to the size of the left ventricular mass (L. V. Mass), calculated according to Devereux R. B. et al.: less than or equal to 200, 201-250, 251-300, 301-350, 351-400, or greater than 400 g. Echo evaluation of coronary artery (c.a.) proximal size was performed following the method described by Kalavathy et al. (J Am Coll cardiol 1986, 8, 1119-1124). Two of us separately conducted the measurement of the c.a. diameter at congruent to 1 cm from the respective aortic ostium on M-Mode tracings and 2-D end-diastolic frames. The inter-observer variability was lower for the M-Mode (4.2%) than 2D (9.3%) measurements: the correlation between A and B observers equals r = 0.867 for the right c.a., and r = 0.859 for the left main c.a.     

Left ventricular hypertrophy in athletes: an exercise-echocardiographic study

Left ventricular dimensions measured by M-mode echocardiography of 10 distance runners and 10 wrestlers were compared to 10 sedentary controls at rest and during 12 min of semisupine, graded bicycle ergometer exercise. At rest, runners and wrestlers demonstrated greater left ventricular mass compared to controls (mean values, 311.8 and 325.9 vs 215.9 g, respectively: P less than 0.05). In wrestlers, this was due to increased left ventricular septal (13.5 mm) and posterior wall thickness (12.9 mm) compared to controls (9.1 and 10.1 mm, respectively: P less than 0.05). In runners, this was due to increased left ventricular end-diastolic dimension (55.8 mm) compared to controls (49.7 mm) (P less than 0.05). During exercise, the different patterns noted at rest among the three groups in left ventricular dimensions and function persisted and were preserved: runners maintained a higher end-diastolic dimension compared to wrestlers and controls and greater shortening dimension compared to wrestlers. Absolute changes in left ventricular parameters from rest to exercise were not significantly different among the three groups. Conclusions: 1) different patterns of left ventricular hypertrophy exist among different types of athletes, with mainly increased wall thickness in primarily statically trained athletes and increased volume in dynamically trained athletes; and 2) these differences observed at rest persist during moderate-intensity, semisupine ergometer exercise and have direct functional significance, thereby emphasizing the differences found in cardiac dimensions among different types of athletes.     

Prospective echocardiographic assessment of androgenic-anabolic steroids effects on cardiac structure and function in strength athletes

Since the abuse of androgenic-anabolic steroids (AAS) has been associated with the occurrence of serious cardiovascular disease in young athletes, we performed two studies to investigate the effects of short-term AAS administration on heart structure and function in experienced male strength athletes, with special reference to dose and duration of drug abuse. In Study 1 the effects of AAS were assessed in 17 experienced male strength athletes (age 31 +/- 7 y) who self-administered AAS for 8 or 12 - 16 weeks and in 15 non-using strength athletes (age 33 +/- 5 y) in a non-blinded design. In Study 2 the effects of administration of nandrolone decanoate (200 mg/wk i. m.) for eight weeks were investigated in 16 bodybuilders in a randomised double blind, placebo controlled design. In all subjects M-mode and two-dimensional Doppler-echocardiography were performed at baseline and after 8 weeks AAS administration. In the athletes of Study 1 who used AAS for 12 - 16 weeks a third echocardiogram was also made at the end of the AAS administration period. Echocardiographic examinations included the determination of the aortic diameter (AD), left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), interventricular septum thickness (IVS), posterior wall end diastolic wall thickness (PWEDWT), left ventricular mass (LVM), left ventricular mass index (LVMI), ejection fraction (EF) and right ventricular diameter (RVD). For assessment of the diastolic function measurements of E and A peak velocities and calculation of E/A ratio were used. In addition, acceleration and deceleration times of the E-top (ATM and DT, respectively) were determined. For evaluation of factors associated with stroke volume the aorta peak flow (AV) and left ventricular ejection times (LVET) were determined. In Study 1 eight weeks AAS self-administration did not result in changes of blood pressure or cardiac size and function. Additionally, duration of AAS self-administration did not have any impact on these parameters. Study 2 revealed that eight weeks administration of nandrolone decanoate did not induce significant alterations in blood pressure and heart morphology and function. Short-term administration of AAS for periods up to 16 weeks did not lead to detectable echocardiographic alterations of heart morphology and systolic and diastolic function in experienced strength athletes. The administration regimen used nor the length of AAS abuse did influence the results. Moreover, it is concluded that echocardiographic evaluation may provide incomplete assessment of the actual cardiac condition in AAS users since it is not sensitive enough to detect alterations at the cellular level. Nevertheless, from the present study no conclusions can be drawn of the cardiotoxic effects of long term AAS abuse.     

Enlarged left atrial dimension in former endurance athletes: an echocardiographic study

For the purpose of characterizing the left side of the heart by M-mode echocardiography in former endurance athletes, 13 subjects with a mean age of 66 years, all having competed in elite sports up to the age of 35, were studied. As controls, 21 men, with a mean age of 69 years considered to be sedentary and having no history or signs of heart disease, were examined. The two groups did not differ with regard to heart rate, blood pressure, weight, and height. The mean left atrial dimension (LAD) in the former athletes was significantly larger than in the sedentary controls: 43 +/- 6 mm and 38 +/- 3 mm, respectively (P less than 0.05). This was also true when LAD was corrected for body surface area (BSA): 22.1 +/- 3.3 mm/m2 and 20.0 +/- 1.8 mm/m2 (P less than 0.05). However, no significant differences were seen between the athletes and sedentary controls in the left ventricular end-diastolic dimension and wall thickness. In conclusion, this study indicates that former endurance athletes have an enlarged left atrium but a normal-sized left ventricle.     

Comparative echocardiographic study of junior and senior basketball players

The echocardiographic data on 14 junior and 15 senior players in a first-division basketball club were compared. No difference was found between the senior and junior players as regards the thickness of the interventricular septum (11.47 vs 11.21 mm) or the thickness of the posterior wall of the left ventricle (9.8 vs 9.86 mm). The adults displayed a larger left ventricular end-diastolic diameter (56.8 vs 53.6 mm, P less than 0.05), end-diastolic volume (194 vs 164 ml, P less than 0.05), stroke volume (142 vs 116 ml, P less than 0.05), right ventricular diameter (27.9 vs 23.2, P less than 0.01), aortic root diameter (35.0 vs 32.0, P less than 0.05), and left atrial diameter (42.7 vs 37.2, P less than 0.01). However, among these, only the stroke volume and right ventricular diameter remained significantly different after normalization to body surface area. A significant difference could not be demonstrated in the linear ejection fraction, the ejection fraction, or the fractionated interventricular septum and posterior wall thicknesses. The examinations indicated that left ventricular hypertrophy had fully developed by the age of 18 years in the basketball players and that there was no further enhancement in adults. However, the left ventricular, right ventricular, and left atrial volume were larger in the adults than in the junior players.     

Exercise cardiac contractility in men and boys: a recovery echocardiographic study

Previous reports have suggested that children possess limited cardiac functional reserve during exercise compared to young adults. In this study, echocardiography was performed immediately after maximal treadmill exercise to measure left ventricular dimensions and shortening fraction (SF) in college men, and these values were compared to previous results in a post-exercise echocardiographic study of prepubertal boys. Post-exercise SF, change in SF from rest, and percent change in SF from rest were all significantly greater in the post-pubertal subjects. In both men and boys changes in SF following exercise were related to reductions in left ventricular end-systolic dimension, with only minor reductions observed in end-diastolic dimension. These findings support the concept that prepubertal subjects may have inferior myocardial function with exercise when compared to young adults.     

Pulmonary and cardiac infections in athletes

Pulmonary and cardiac infections in the athlete can have a wide range of presentations and complications. These infections may present few problems for the training athlete or become life threatening. The team physician must be able to make an accurate diagnosis, give the appropriate treatment, understand the potential complications, and ensure proper follow-up and return-to-play protocols.     

RAS genes influence exercise-induced left ventricular hypertrophy: an elite athletes study

PURPOSE: The association of ACE I/D polymorphism with changes in LV mass in response to physical training has been observed, but no association has been found with AT1R A1166C polymorphism. We investigated the ACE I/D, AT1R A1166C, and AT1R CA microsatellite polymorphisms genotype distribution in elite athletes and whether the presence of AT1R C1166 variant, in addition to ACE D allele affects the training-induced LV mass alterations in elite trained athletes. METHODS: The study population comprised 28 healthy players recruited from an Italian elite male soccer team and 155 healthy male subjects. LV mass, LV mass adjusted for body surface area, septal thickness, posterior wall, end-diastolic and end-systolic ventricular dimension, and ejection fraction were determined by echocardiography in pretrained period, at rest and 7 months later during the training. All subjects were genotyped for ACE I/D, AT1R A1166C, and CA microsatellite polymorphisms. RESULTS: Training induced an LV mass increase in all but six athletes. The percentage of athletes in whom an increase of LV mass was found after training was statistically different in relation to the ACE D allele: no increase was observed in three of 24 D allele carriers and in three of four II genotype players (Fisher's exact test, P = 0.02). As AT1R is concerned, no increase was observed in 4 of 15 C allele carriers and in 2 of 13 AA genotype athletes (Fisher's exact test, P > 0.05). The contemporary presence of ACE D and AT1R C allele did not affect the changes after training. No difference has been observed in the CA microsatellite marker allele frequencies between athletes and controls (P = 0.46). CONCLUSION: In this study, we provide the evidence that soccer play does not select athletes on genotype basis. Training-induced LV mass changes in male elite athletes are significantly associated with the presence of ACE D allele, but not of AT1R C allele.     

Performance parameters in children and adolescent athletes

Success in sports, as measured by competitive performance, is dependent upon a number of significant mental and physical components. Somatotype, motor skills, age, nutritional status, physiology, psychology, training level, genetic endowment, and injury risk are the major independent variables influencing performance. Unfortunately, the data available in this area of sports medicine are not always reliable or allow interstudy comparisons. This article reviews the historical and current information used to predict human performance in sports at the childhood and adolescent level. Although mesomorphy, and to a lesser extent ectomorphy, are positively associated with enhanced performance, successful athletes tend to have or acquire somatotypes characteristic of individuals already successful in a particular sport. For the most part, motor skills are age (chronological) and gender dependent. In general, the efficiency of movement progressively improves throughout childhood and into early adolescence and is highly dependent on environmental influences. A lower anaerobic and aerobic capacity reduces performance in the child and adolescent. Nonetheless, regular training can favourably improve motor skills and physiological fitness parameters. The relationship between endurance performance and aerobic capacity, however, is not strong at any age during childhood. Performance levels are reduced if nutrition is inadequate. A number of mental factors such as aggression, spirit, and self-confidence are also related to sports performance, although their correlation is unclear at present. Performance is influenced by the effect of genetic factors on specific traits in 30 to 85% of cases. Risk factors that negatively impact on performance levels include a history of previous injury, excessive training schedules, decreased fitness endurance, joint looseness or tightness, and certain personality traits. It is suggested that sport performance may be optimised by the early identification of individuals with positive genetic and somatotypic markers and negative risk factors. Motor skill development and physiological parameters can then be maximised by using regular, non-excessive training protocols, sound nutrition patterns, a safe environment and protective gear. Further investigations in this important area of sports medicine are essential in order to more fully characterise those criteria essential for successful sports participation. In particular, such studies should be purely longitudinal and should control for multiple confounding factors operating at different times.     

QT dispersion in elderly athletes with left ventricular hypertrophy

The purpose of this study was to examine the QT dispersion in elderly endurance athletes with left ventricular (LV) hypertrophy. Sixteen athletes (males, mean age 67.6 +/- 4.5 years) with mild to moderate LV hypertrophy, were compared with 16 age-matched hypertensive patients with similar degree of LV hypertrophy and 16 age-matched healthy sedentary controls. All the participants underwent echocardiogram and 12-lead electrocardiogram. QT dispersion was defined as the difference between maximum and minimum QT intervals in the different leads. QT dispersion was corrected (QTc) for heart rate according to Bazett's formula. The results showed in athletes and hypertensive patients comparable LV mass (258.2 +/- 14.2 vs. 262.4 +/- 16.8 g, ns), which was significantly higher than that of controls (p < 0.001). Trained subjects had QT dispersion (38.6 +/- 10.2 ms) and QTc dispersion (39.4 +/- 11.3 ms) significantly lower than hypertensive patients (QT dispersion: 68.4 +/- 11.4 ms; QTc dispersion: 72.2 +/- 8.4, p < 0.001) and comparable with controls (QT dispersion: 44.3 +/- 8.4 ms; QTc dispersion: 46.2 +/- 6.2 ms, ns). In conclusion, in elderly athletes training-induced myocardial hypertrophy was characterized by a QT dispersion significantly lower than hypertensive myocardial hypertrophy. This could provide a simple and inexpensive screening method for differentiating physiologic from pathologic myocardial hypertrophy in elderly subjects.     

Echocardiographic left ventricular hypertrophy in Chinese endurance athletes.

Most echocardiographic data on the athletic heart syndrome originate from the United States and Western Europe. There are no published data on echocardiographically documented left ventricular hypertrophy in Asian athletes. We investigated the echocardiographic changes which take place with endurance training by studying eight Hong Kong national cyclists. This study confirms that left ventricular hypertrophy and increased left ventricular end-diastolic dimensions are common findings in Chinese endurance athletes as in their Caucasian counterparts. Calculated left ventricular muscle mass exceeded the 95th percentile in seven of eight subjects.     

Overview of sudden cardiac death in young athletes

Sudden cardiac death is the leading cause of nontraumatic mortality in young athletes. The estimated incidence varies; however, recent studies have provided more accurate data. Most cases are attributed to silent hereditary or congenital cardiac disorders, many of which may be detected through preparticipation screening programs. This article provides a comprehensive review of the incidence and etiology of sudden cardiac death in young athletes, with practical advice regarding evaluation and management in light of a large number of recent advances. A brief outline of current perspectives on preparticipation screening programs and prevention is included.     

Comparative study of central hemodynamics, myocardial contractility and left-ventricular wall tension in athletes and patients

The purpose of the study was to extend our knowledge about the "athletic" heart and improve diagnosis of latent manifestations of cardiac insufficiency. Echocardiography was used to examine central hemodynamics, myocardial contractility and left-ventricle wall tension in athletes and patients with ischemic heart disease (IHD) and arterial hypertension at rest and after exercise tests. The study of time-course variations of these parameters revealed different patterns of initial dilation and development of further dilation and hypertrophy in athletes and patients. The most sensitive index of contractility was meridional and circular tension of the left-ventricle wall which was the lowest in athletes and the highest in IHD patients.     

Absence of training-specific cardiac adaptation in paraplegic athletes

PURPOSE: The distinctive nature of left ventricular (LV) adaptation reported in able-bodied endurance- and power-trained athletes probably reflects the different hemodynamic loading patterns that occur during acute exercise. The exercise-induced hemodynamic loads in spinal cord injured athletes are different to those in able-bodied counterparts (lower venous return and stroke volume, higher heart rate). We sought to test the hypothesis that wall thickness, but not chamber dimension, would be larger in endurance- and power-trained spinal cord injured athletes compared with sedentary spinal cord injured subjects. METHODS: We undertook resting two-dimensional, motion-mode, and Doppler examinations of 11 power-trained, 10 endurance-trained, and 5 sedentary spinal cord injured volunteers and compared structural and functional LV data by using ANOVA. LV structural data were also analyzed after being scaled to body mass (BM)(0.33). RESULTS: There were no statistically significant differences among groups for any of the LV structural or functional measurements. However, there was a trend for larger mean wall thickness (0.95 +/- 0.12 vs 0.83 +/- 0.10 cm) and left ventricular mass (193 +/- 57 vs 164 +/- 66 g) in athletes compared with sedentary individuals. CONCLUSION: It seems unlikely that endurance and power training elicits distinctive patterns of LV enlargement in spinal cord injured athletes. Small adaptations of the left ventricle may occur with athletic training in the spinal cord injured athlete. Research within this population is complicated by extreme heterogeneity in important physical, physiological, and athletic-related variables.     

Inheritance of acute cardiac changes during bicycle exercise: an echocardiographic study in twins.

The inheritance of cardiac changes during acute dynamic physical exercise was studied in 21 pairs of monozygotic and 12 pairs of dizygotic male twins, ages 18-31 yr. Echocardiography was performed in resting conditions and at submaximal supine bicycle exercise at a heart rate of 110 bpm. In resting conditions significant heritability could be demonstrated for end-diastolic mean wall thickness, but not for left ventricular diameter and fractional shortening. Also for the change of mean wall thickness from rest to exercise, no significant heritability could be demonstrated. The increase of end-diastolic left ventricular internal dimension from rest to exercise showed a genetic component of 24% (P less than 0.05). Inheritance accounted for 47% (P less than 0.001) of the total phenotypic variance of the increase of fractional shortening from rest to exercise. In conclusion, the data suggest that the capacity of increasing end-diastolic left ventricular internal dimension and increasing fractional shortening during submaximal exercise has, unlike findings at rest, a significant genetic component.