Structure and function of distance runners' heart (original) (raw)
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Cardiac Dimensions Over 5 Years in Highly Trained Long-Distance Runners and Sprinters
The Physician and Sportsmedicine, 2010
We assessed the changes in cardiac morphology between elite endurance-trained runners (n = 42) and elite sprinters (n = 34) over a 5-year period. In addition, we studied the relationship between heart size and maximum oxygen consumption (VO 2 max). Methods: At the beginning of 5 consecutive seasons, all athletes underwent an incremental running test to determine VO 2 max and a color-coded pulsed Doppler examination to determine baseline echocardiographic variables. We hypothesized that cardiac morphology had reached its upper limit in elite athletes, and showed only minor changes during 5 years of regular training. Results: Although all echocardiographic variables remained stable in nearly all sprinters studied, in the endurance runners (who presented higher cardiac cavity dimensions compared with sprinters), variations in heart morphology became evident from the third season, and were within established physiological limits. Conclusion: Only 6 (17%) endurance runners and 3 (9%) sprinters showed a left ventricular internal diameter of . 60 mm (the threshold pathological value) at end diastole at some point during the observational period. Moreover, no statistically significant association was detected between changes in VO 2 max and changes in heart size. After 5 years of intense training, the changes of the echocardiographic variables examined remained different between endurance runners and sprinters.
Echocardiographic right and left ventricular measurements in male elite endurance athletes
European Heart Journal, 1996
Echocardiography was used to assess normal values in the right and left ventricular cavity and wall in 127 male elite endurance athletes. M-mode and two dimensional measurements of left ventricle and left and right atria were also obtained. All subjects were high-performance orienteers, crosscountry skiers and middle-distance runners. They all had a normal electrocardiogram at rest and no echocardiographic evidence of heart disease. With the use of multiple right ventricular cross-sections and two-dimensional measurements, we found a significantly greater right ventricular inflow tract and right and left atrial measurements in endurance athletes compared with earlier studies of normal, active subjects. The right ventricular free wall was slightly thicker than reported in normal active subjects but the differences were small. Left ventricular diastolic diameter was consistent with previous reports of endurance athletes. Of the 127 subjects, 13% had left ventricular wall thickness above 13 mm but none of the athletes had wall thickness above 15mm. These data suggest that cardiac enlargement occurs symmetrically in both right and left cavities, probably reflecting increased haemodynamic loading, a mechanism by which athletes sustain a high cardiac output during exercise.
Echocardiography, 2006
The impact of prolonged exercise upon right ventricular (RV) function is poorly understood and to date no studies have utilized tissue-Doppler imaging (TDI). Thirty-five marathon runners (age range 18-50 years) volunteered for the study. Two-dimensional, pulsed Doppler, and TDI studies were performed one day before and immediately following race completion. Right and left ventricular (LV) longitudinal TDI myocardial velocities were acquired from the tricuspid annulus and mitral annulus, providing velocity data during systole (S ), early diastole (E ), and late diastole (A ). Transtricuspid and transmitral, early diastolic (E), and late diastolic (A) velocities and ratios were assessed using conventional pulsed-wave Doppler. RV and LV fractional area changes (FAC) were calculated from RV and LV end-diastolic and end-systolic areas recorded from 2D scans in a subsample (n = 23). RV myocardial velocities were unchanged pre-post race in S (21.1 ± 2.7 to 21.7 ± 4.5 cm s −1 , P > 0.05), reduced in E (23.3 ± 3.5 to 19.9 ± 5.3 cm s −1 , P < 0.05), increased in A (19.1 ± 3.6 to 23.7 ± 6.8 cm s −1 , P < 0.05) with a resultant decline in E /A (1.28 ± 0.36 to 0.94 ± 0.45, P < 0.05). This pattern of data was mirrored in the LV. Similarly both pulsed-Doppler tricuspid and mitral E/A ratios decreased from pre-to postrace (P < 0.05). FAC for the RV and LV were unaltered postrace (P > 0.05). The impact of differing age, finishing time (173-330 min), hemodynamic loading and heart rate upon RV and LV function pre-to postrace was negligible. In conclusion, TDI and 2D data, for both the RV and LV demonstrated little change in systolic function after a marathon race. Conversely, a reduction in diastolic function was observed in both ventricles for which a mechanism has yet to be deduced. (ECHOCARDIOGRAPHY, Volume 23, September 2006) tissue Doppler, diastolic function, cardiac fatigue While data has been presented for a postexercise decline in left ventricular (LV) systolic function and/or diastolic filling 1,2 we understand less about the potential impact of prolonged exercise on the right ventricle (RV). This is partially due to the difficulties in obtaining reliable and accurate data, especially in noninvasive imaging studies. To date only three studies have assessed RV function after prolonged exercise (see ). There is some suggestion from these studies that the RV may show earlier or more pronounced signs of "exercise-induced cardiac fatigue" in welltrained ultra-endurance athletes after competition. 3-5 This could be due to the fact that RV stroke work increases more, relatively, than LV stroke work with the imposition of exercise. The postulated reason for this is a greater relative increase in arterial pressure and a smaller relative decrease in peripheral resistance in the pulmonary compared to the systemic circulation. It is unclear what the consequences of shorter bouts of exercise (such as a marathon), in a more heterogenous group of athletes in terms of age and fitness level, are on postexercise RV function.
Impact of marathon running on cardiac structure and function in recreational runners
Clinical Science, 2005
The present study examined the relationship between LV (left ventricular) function, markers of cardiac-specific damage and markers of oxidative stress in recreational runners following a marathon. Runners (n = 52; 43 male and nine female; age, 35 + − 10 years; height, 1.74 + − 0.08 m; body mass, 75.9 + − 8.9 kg) were assessed pre-and immediately post-marathon. LV function was assessed using standard M-mode two-dimensional Doppler echocardiography and TDI (tissue-Doppler imaging) echocardiography. Serum was analysed for cTnT (cardiac troponin-T), TEAC (Trolox equivalent antioxidant capacity; a measure of total antioxidant capacity), MDA (malondealdehyde) and 4-HNE (4-hydroxynonenal). A strong relationship was observed between standard and TDI echocardiography for all functional measures. Diastolic function was altered postmarathon characterized by a reduction in E (peak early diastolic filling: 0.79 + − 0.11 compared with 0.64 + − 0.16 cm/s; P < 0.001), an increase in A (peak late diastolic filling: 0.48 + − 0.11 compared with 0.60 + − 0.12 cm/s; P < 0.001) and a resultant decrease in E/A (ratio of E to A; 1.71 + − 0.48 compared with 1.10 + − 0.31; P < 0.001). Ejection fraction remained unchanged post-marathon. Thirtytwo runners presented with cTnT values above the lower limit of detection for the assay (0.01 µg/l), and 20 runners presented post-marathon with cTnT values above the acute myocardial infarction cut-off value (0.05 µg/l). No significant correlations were observed between cTnT and any functional measurements. MDA (2.90 + − 1.58 compared with 3.59 + − 1.47 µmol/l) and TEAC (1.80 + − 0.12 compared with 1.89 + − 0.21 mmol/l) were significantly increased post-marathon, but were unrelated to changes in function or cTnT. In conclusion, the present study demonstrated a reduction in diastolic function and widespread evidence of minimal cardiac damage following a marathon in recreational runners. The mechanism(s) underpinning the altered function and appearance of cTnT appear unrelated to reactive oxygen species.
Echocardiographic parameters in athletes of different sports
Journal of sports science & medicine, 2008
Competitive athletics is often associated with moderate left ventricular (LV) hypertrophy, and it has been hypothesized that training mode and type of exercise modulates long-term cardiac adaptation. The purpose of the study was to compare cardiac structure and function among athletes of various sports and sedentary controls. Standard transthoracic two-dimensional M-mode and Doppler echocardiography was performed at rest in Caucasian male canoe/kayak paddlers (n = 9), long distance runners (LDR, n = 18), middle distance runners (MDR, n = 17), basketball players (BP, n = 31), road cyclists (n = 8), swimmers (n = 10), strength/power athletes (n = 9) of similar age (range, 15 to 31 yrs), training experience (4 to 9 years), and age-matched healthy male sedentary controls (n = 15). Absolute interventricular septum (IVS) thickness and LV wall thickness, but not LV diameter, were greater in athletes than sedentary controls. Left ventricular mass of all athletes but relative wall thickness ...
Current Cardiology Reports, 2013
To go too far is as bad as to fall short."Confucius (BC 551-BC 479) Chinese philosopher Echocardiography has contributed most to our current understanding and indeed our current dilemma regarding the heart of the endurance athlete. Echocardiography assesses and characterizes nicely the effects of Endurance exercise training. It allows us to assess both systolic and diastolic cardiac variables as they change with structure and function associated with intense sporting activity. Much research work using echocardiography has characterized the left and right ventricle of the endurance athlete over the last year. Indeed evidence suggests that intense prolonged exercise may result in myocardial dysfunction which predominantly affects the RV, and that chronic RV remodelling may represent a substrate for ventricular arrhythmias in athletes. This has been the source of many debates and articles over the last 12 months. The reasons underlying the predilection towards RV dysfunction with intense prolonged exercise and the variation between individuals in its occurrence are still under dispute. This article seeks to describe the recent literature over the last year which outlines the different areas research has focused on when we assess the heart of the endurance athletes using echocardiography. Ultimately the goal of all research on the heart of the endurance athletes is to search for the holy grail of when enough is enough and therefore recognize and embrace the delicate balance of endurance intensity, in other words the border line when endurance exercise is no longer beneficial but slumps and slides into the realms of induced cardiac pathology.
Right and left ventricular diastolic function of male endurance athletes
International Journal of Cardiology, 2004
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 À 1 min À 1 ) (59.5 vs. 33.5, P < 10 À 3 ) and left ventricular mass (g) (281 vs. 202, P < 10 À 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 À 0.4 age, r 2 = 0.75, P = 10 À 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. D