The Upper Limit of Physiological Cardiac Hypertrophy in Elite Male Athletes (original) (raw)
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European Journal of Applied Physiology, 2004
Establishment of upper normal limits of physiological hypertrophy in response to physical training is important in the differentiation of physiological and pathological left ventricular hypertrophy. The genetic differences that exist in the adaptive response of the heart to physical training and the causes of sudden cardiac death in young athletes indicate the need for population-specific normal values. Between September 1994 and December 2001, 442 (306 male, 136 female) elite British athletes from 13 sports were profiled. Standard two-dimensional guided M-mode and Doppler echocardiography were employed to evaluate left ventricular morphology and function. Eleven (2.5%) athletes, competing in a range of sports including judo, skiing, cycling, triathlon, rugby and tennis, presented with a wall thickness >13 mm, commensurate with a diagnosis of hypertrophic cardiomyopathy. Eighteen (5.8%) male athletes presented with a left ventricular internal diameter during diastole (LVIDd) >60 mm, with an upper limit of 65 mm. Of the 136 female athletes, none where found to have a maximum wall thickness >11 mm. Left ventricular internal diameter was <60 mm in all female athletes. Systolic and diastolic function were within normal limits for all athletes. Upper normal limits for left ventricular wall thickness and LVIDd are 14 mm and 65 mm for elite male British athletes, and 11 mm and 60 mm for elite female British athletes. Values in excess of these should be viewed with caution and should prompt further investigation to identify the underlying mechanism.
[Left ventricular hypertrophy of athletes: adaptative physiologic response of the heart]
Arquivos brasileiros de cardiologia, 2005
To verify whether left ventricular hypertrophy (LVH) of elite competition athletes (marathoners) represents a purely physiological, adaptative process, or it may involve pathological aspects in its anatomical and functional characteristics. From November 1999 to December 2000, consecutive samples from 30 under 50-year-old marathoners in full sportive activity, with previously documented LVH and absence of cardiopathy were selected. They were submitted to clinical exams, electrocardiogram, color Doppler echocardiogram and exercise treadmill test (ETT). Fifteen were assorted to be also submitted to ergoespirometric test and heart magnetic resonance imaging (MRI). In ETT, all of them showed good physical pulmonary capacity, with no evidences of ischemic response to exercise, symptoms or arrhythmias. In Doppler echocardiogram, values of diameter and diastolic thickness of LV posterior wall, interventricular septum, LV mass and left atrium diameter, were significantly higher when compare...
ATHLETE’S HEART: THE LEFT VENTRICULAR REMODELING IN PAKISTANI ELITE ENDURANCE ATHLETES
Gomal J Med Sci , 2013
Background: Top-level physical training is often associated with morphological changes in heart including increased left ventricular cavity dimension, wall thickness and mass. The objective of this study was to find out the differences in ventricular chamber size and wall thickness in Pakistani elite endurance athletes as compared to age and Body Mass Index matched controls. . A sample of 44 male subjects was selected, comprised of 22 elite endurance athletes (group 1) and 22 age and BMI matched healthy sedentary volunteers as controls (group 2). All those with cardiopulmonary diseases or having family history of these diseases were excluded. M-mode echocardiography was carried out. Age, weight, height and Body Mass Index were demographic variables while left ventricular end-diastolic internal diameter, diastolic interventricular septal thicknesses, left ventricular posterior wall thickness, and left ventricular mass were research variables. All these data were of ratio type, hence described by mean and standard deviation. The significance of the mean differences for all the variables was derived by student t test. Alpha value of 0.5 was considered as statistically significant.
Sport Sciences for Health, 2012
The identification of left ventricular hypertrophy (LVH) through electrocardiographic voltage criteria has been widely studied in patients. However, their validity in ''athlete's heart'' remains quite unknown. The aim of this study was to evaluate the most common electrocardiographic indices indicative of LVH compared to the known echocardiographic ones in athletes. The study group comprised 150 male adult competitive athletes (group A) and 50 sedentary participants (group B). Thirteen accepted electrocardiographic voltage criteria indicative of LVH were calculated and correlated with the common echocardiographic indices of left ventricular mass (LVM). Nine of the 13 ECG voltage criteria were significantly increased in athletes compared to controls. Statistically, the Sokolow-Lyon index, which is the most commonly used voltage index was found to be affected by the body mass index (10.7 %, p \ 0.05), the group (7.3 %, p \ 0.05) and systolic blood pressure (4.5 %, p \ 0.05) in total variance of 16.6 % (p \ 0.05). No electrocardiographic voltage criterion was significantly correlated with any echocardiographic index, except for the Cornell index that was correlated with end-diastolic volume index (r = 0.29, p \ 0.05) and the Sokolow index (V6) with LVMI (r = 0.26, p \ 0.05) in group A. We suggested that ECG voltage indices should not be considered valid when assessing LVH in athletes. Thus, the echocardiographic study is preferable in studying training-induced structural cardiac changes.
International Journal of Cardiology, 2006
Aim: To study, by conventional echocardiography, left ventricular remodelling and function in master athletes, hypertension and hypertrophic cardiomyopathy. Methods: We studied 30 master athletes (MA; soccer players; mean age 43.9 T 5.9), 24 subjects with essential hypertension (HYP; 46.6 T 6), 20 patients with hypertrophic cardiomyopathy (HCM; 42.2 T 9) and 30 normal individuals (CG; 43.4 T 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. Results: 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 T 0.39 vs. 4.91 T 0.19; P = 0.0002). Conclusion: 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. D
An Echocardiographic Study of Heart in a Group of Male Adult Elite Athletes
2008
Background: Severe and prolonged physical training is associated with morphological and physiological cardiac changes, often termed as the "athlete's heart". Echocardiographic features peculiar to elite Iranian athletes have not been previously described. The aim was to examine the echocardiographic characteristics of highly trained Iranian athletes involved in three different sports.
Predominance of normal left ventricular geometry in the male 'athlete's heart
Heart, 2014
Aims This study evaluated (a) global LV adaption to endurance versus resistance training in male athletes, (b) LV assessment using by modern imaging technologies and (c) the impact of scaling for body size on LV structural data. Methods A prospective cross-sectional design assessed the LV in 18 elite endurance-trained (ET), 19 elite resistance-trained (RT) and 17 sedentary control (CT) participants. Standard 2D, tissue Doppler and speckle tracking echocardiography assessed LV structure and function. Indexing of LV structures to body surface area (BSA) was undertaken using ratio and allometric scaling. Results Absolute and scaled LV end-diastolic volume (ET: 43.7±6.8; RT: 34.2±7.4; CT 32.5±8.9 mL/m 1.5 ; p<0.05) and LV mass (ET: 29.8±6.6; RT: 25.4±8.7; CT 25.9±6.4 g/m 2.7 ; p < 0.05) were significantly higher in ET compared with RT and CT. LV wall thickness were not different between ET and RT. 65% of ET and 95% of RT had normal geometry. Stroke volume was higher in ET compared with both RT and CT ( p<0.05). Whilst regional tissue velocity data were not different between groups, longitudinal and basal circumferential strain (ε) was reduced in RT compared with ET. Conclusions In this comprehensive evaluation of the male athlete's heart (AH), normal LV geometry was predominant in both athlete groups. In the ET, 30% demonstrated an eccentric hypertrophy with no concentric hypertrophy in RT. Cardiac ε data in RT require further evaluation, and any interpretation of LV size should appropriately index for differences in body size.
Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy
Journal of The American College of Cardiology, 1985
Left ventricular hypertrophy due to aortic stenosis, hypertension and other forms of heart disease is associated with abnormalities of diastolic function. It is uncertain whether these changes are an inherent consequence of the hypertrophic process or represent additional pathologic factors. To investigate this issue, echocardiographic indexes of left ventricular early diastolic function in highly trained athletes were compared with those in age-matched normal control subjects. Athletes were equally classified into two groups: II swimmers who had a pattern of myocardial hypertrophy with normal wall thickness to dimension ratio and 11 power lifters whose wall thickness to dimension ratio was increased.
2024
To evaluate the morphology of the "athlete's heart", left ventricular (LV) wall thickness (WT) and end-diastolic internal diameter (LVIDd) at rest were addressed in publications on skiers, rowers, swimmers, cyclists, runners, weightlifters (n = 927), and untrained controls (n = 173) and related to the acute and maximal cardiovascular response to their respective disciplines. Dimensions of the heart at rest and functional variables established during the various sport disciplines were scaled to body weight for comparison among athletes independent of body mass. The two measures of LV were related (r = 0.8; P = 0.04) across athletic disciplines. With allometric scaling to body weight, LVIDd was similar between weightlifters and controls but 7%-15% larger in the other athletic groups, while WT was 9%-24% enlarged in all athletes. The LVIDd was related to stroke volume, oxygen pulse, maximal oxygen uptake, cardiac output, and blood volume (r = ~ 0.9, P < 0.05), while there was no relationship between WT and these variables (P > 0.05). In conclusion, while cardiac enlargement is, in part, essential for the generation of the cardiac output and thus stroke volume needed for competitive endurance exercise, an enlarged WT seems important for the development of the wall tension required for establishing normal arterial pressure in the enlarged LVIDd.
Journal of the American College of Cardiology 16 1431 1436, 2002
The present study was undertaken to define physiologic limits of left ventricular hypertrophy in elite adolescent athletes. BACKGROUND Systematic sports training may cause increased left ventricular wall thickness (LVWT), creating uncertainty regarding the differential diagnosis of athlete's heart from hypertrophic cardiomyopathy (HCM). This distinction is crucial because HCM is responsible for about one-third of all sudden deaths in young athletes. Echocardiographic data defining athlete's heart are limited largely to adults, with little information specifically in adolescent athletes (14 to 18 years old), for whom the risk of sudden death from HCM is highest.