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Monosilio S, Squeo MR, Maestrini V. Controversies in sports cardiology: Is physical activity a benefit or a double-edged sword? This Editorial Refers to "Extreme endurance training and coronary artery disease: A systematic review and a meta-analysis" by Guarnieri G et Al. Int J Cardiol 2025; 434:133348. [PMID: 40339752 DOI: 10.1016/j.ijcard.2025.133348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2025] [Accepted: 04/30/2025] [Indexed: 05/10/2025]
Affiliation(s)
- Sara Monosilio
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy.
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Ainab I, Van Ochten N, Suckow E, Pierce K, Arent C, Kay J, Forbes LM, Cornwell WK. Determinants of cardiac output in health and heart failure. Exp Physiol 2025; 110:637-648. [PMID: 40121540 PMCID: PMC12053893 DOI: 10.1113/ep091505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 02/20/2025] [Indexed: 03/25/2025]
Abstract
Sustained physical exercise depends on delivery of oxygenated blood to exercising muscle. At least among healthy individuals, bulk transport of blood is tightly matched to metabolic demand, such that cardiac output increases by ∼6 L/min for every 1 L/min increase in oxygen uptake. Multiple factors contribute to the regulation of cardiac output, including central command, the exercise pressor reflex (EPR) and arterial baroreceptors. Pulmonary arterial and left ventricular pressures increase in proportion to the rise in cardiac output and exercise intensity. The right ventricle augments contractility to maintain ventricular-arterial (VA) coupling and lusitropy to facilitate venous return. Among patients with heart failure (HF), however, the ability to deliver blood to exercising muscle is compromised as a result of multiple abnormalities impacting EPR, ventricular contractility, haemodynamics and VA coupling. The purpose of this review is to provide an overview of the factors limiting exercise capacity and cardiac output among patients with HF compared to what is known about normal physiology among healthy individuals.
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Affiliation(s)
- Ibrahim Ainab
- Department of Medicine‐CardiologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Natalie Van Ochten
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Emmett Suckow
- Department of Medicine‐CardiologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kathryn Pierce
- Clinical Translational Research CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Chelsea Arent
- Clinical Translational Research CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Joseph Kay
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Lindsey M. Forbes
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - William K. Cornwell
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Clinical Translational Research CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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D'Ambrosio P, De Paepe J, Janssens K, Mitchell AM, Rowe SJ, Spencer LW, Van Puyvelde T, Bogaert J, Ghekiere O, Pauwels R, Herbots L, Robyns T, Kistler PM, Kalman JM, Heidbuchel H, Willems R, Claessen G, La Gerche A. Arrhythmias and structural remodeling in lifelong and retired master endurance athletes. JOURNAL OF SPORT AND HEALTH SCIENCE 2025:101043. [PMID: 40273982 DOI: 10.1016/j.jshs.2025.101043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 02/01/2025] [Accepted: 03/10/2025] [Indexed: 04/26/2025]
Abstract
BACKGROUND A greater prevalence of arrhythmias has been described in endurance athletes, but it remains unclear whether this risk persists after detraining. We aimed to evaluate the prevalence of arrhythmias and their relationship with cardiac remodeling in lifelong and retired master endurance athletes compared to non-athletic controls. METHODS We performed a cross-sectional analysis of observational studies that used echocardiography and cardiac magnetic resonance to detail cardiac structure and function, and Holter monitors to identify atrial and ventricular arrhythmias in 185 endurance athletes and 81 non-athletic controls aged ≥40 years. Athletes were categorized as active lifelong (n = 144) or retired (n = 41) based on hours per week of high-intensity endurance exercise within 5 years of enrollment and validated by percentage of predicted maximal oxygen consumption (VO2max). Athletes with overt cardiomyopathies, channelopathies, pre-excitation, and/or myocardial infarction were excluded. RESULTS Lifelong athletes (median age = 55 years (interquartile range (IQR): 46-62), 79% male) were significantly fitter than retired athletes (median age = 66 years (IQR: 58-71), 95% male) and controls (median age = 53 years (IQR: 48-60), 96% male), respectively (predicted VO2max: 131% ± 18% vs. 99% ± 14% vs. 98% ± 15%, p < 0.001). Compared to controls, athletes in our cohort had a higher prevalence of atrial fibrillation ((AF): 32% vs. 0%, p < 0.001) and non-sustained ventricular tachycardia ((NSVT): 9% vs. 1%, p < 0.001). There was no difference in prevalence of any arrhythmia between lifelong and retired athletes. Lifelong athletes had larger ventricular volumes than retired athletes, who had ventricular volumes similar to controls (left ventricular end-diastolic volume indexed to body surface area (LVEDVi): 101 ± 20 mL/m2vs. 86 ± 16 mL/m2vs. 94 ± 18 mL/m2, p < 0.001; right ventricular end-diastolic volume indexed to body surface area (RVEDVi): 117 ± 23 mL/m2vs. 101 ± 19 mL/m2vs. 100 ± 19 mL/m2, p < 0.001). Athletes had more scar (40% vs. 18%, p = 0.002) and larger left atria (median volume = 45 mL/m2 (IQR: 38-52) vs. 31 mL/m2 (IQR: 25-38), p < 0.001) than controls, with no difference in atrial volumes and non-ischaemic scar between the athlete groups. CONCLUSION Master endurance athletes have a higher prevalence of AF and NSVT than non-athletic controls. Whereas ventricular remodeling tends to reverse with detraining, the propensity to arrhythmias persists regardless of whether they are actively exercising or retired.
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Affiliation(s)
- Paolo D'Ambrosio
- Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia; Heart, Exercise & Research Trials (HEART) lab, St Vincent's Institute, Fitzroy, VIC, 3065, Australia; Department of Cardiology, The Royal Melbourne Hospital, Parkville, VIC, 3010, Australia.
| | - Jarne De Paepe
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, 3000, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 3000, Belgium
| | - Kristel Janssens
- Heart, Exercise & Research Trials (HEART) lab, St Vincent's Institute, Fitzroy, VIC, 3065, Australia; The Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - Amy M Mitchell
- Heart, Exercise & Research Trials (HEART) lab, St Vincent's Institute, Fitzroy, VIC, 3065, Australia
| | - Stephanie J Rowe
- Heart, Exercise & Research Trials (HEART) lab, St Vincent's Institute, Fitzroy, VIC, 3065, Australia; Department of Cardiology, St. Vincent's Hospital, Fitzroy, VIC, 3065, Australia
| | - Luke W Spencer
- Heart, Exercise & Research Trials (HEART) lab, St Vincent's Institute, Fitzroy, VIC, 3065, Australia
| | - Tim Van Puyvelde
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, 3000, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 3000, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, Katholieke Universiteit Leuven, Leuven, 3000, Belgium; Department of Radiology, University Hospitals Leuven, Leuven, 3000, Belgium
| | - Olivier Ghekiere
- Department of Radiology, Jessa Ziekenhuis, Hasselt, 3500, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, UHasselt, Biomedical Research Institute, Diepenbeek, Hasselt, 3500, Belgium
| | - Rik Pauwels
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, 3000, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 3000, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, UHasselt, Biomedical Research Institute, Diepenbeek, Hasselt, 3500, Belgium
| | - Lieven Herbots
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, UHasselt, Biomedical Research Institute, Diepenbeek, Hasselt, 3500, Belgium; Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, 3500, Belgium
| | - Tomas Robyns
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, 3000, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 3000, Belgium
| | - Peter M Kistler
- Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, VIC, 3004, Australia; Department of Medicine, Monash University, Clayton, VIC, 3168, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Jonathan M Kalman
- Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia; Department of Cardiology, The Royal Melbourne Hospital, Parkville, VIC, 3010, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, 2650, Belgium; Research Group Cardiovascular Diseases, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR) Department, University of Antwerp, Antwerp, 2610, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, 3000, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 3000, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, 3000, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, UHasselt, Biomedical Research Institute, Diepenbeek, Hasselt, 3500, Belgium; Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, 3500, Belgium
| | - André La Gerche
- Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia; Heart, Exercise & Research Trials (HEART) lab, St Vincent's Institute, Fitzroy, VIC, 3065, Australia; Department of Cardiology, St. Vincent's Hospital, Fitzroy, VIC, 3065, Australia; HEART Lab, Victor Chang Cardiovascular Research Institute, Darlinghurst, NSW, 2010, Australia
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Ichimura K, Gross A, Mathew RO, Salman L, Reddy S, Spiekerkoetter E, Sidhu MS. Cardiorenal Syndrome in Right Heart Failure Due to Pulmonary Arterial Hypertension-The Right Ventricle as a Therapeutic Target to Improve Renal Function. Cardiovasc Drugs Ther 2025; 39:373-384. [PMID: 38847906 DOI: 10.1007/s10557-024-07588-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 03/30/2025]
Abstract
Cardiorenal syndrome (CRS) due to right ventricular (RV) failure is a disease entity emerging as a key indicator of morbidity and mortality. The multifactorial aspects of CRS and the left-right ventricular interdependence complicate the link between RV failure and renal function. RV failure has a direct pathophysiological link to renal dysfunction by leading to systemic venous congestion in certain circumstances and low cardiac output in other situations, both leading to impaired renal perfusion. Indeed, renal dysfunction is known to be an independent predictor of mortality in patients with pulmonary arterial hypertension (PAH) and RV failure. Thus, it is important to further understand the interaction between the RV and renal function. RV adaptation is critical to long-term survival in patients with PAH. The RV is also known for its remarkable capacity to recover once the aggravating factor is addressed or mitigated. However, less is known about the renal potential for recovery following the resolution of chronic RV failure. In this review, we provide an overview of the intricate relationship between RV dysfunction and the subsequent development of CRS, with a particular emphasis on PAH. Additionally, we summarize potential RV-targeted therapies and their potential beneficial impact on renal function.
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Affiliation(s)
- Kenzo Ichimura
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Stanford University, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA, 94305, USA.
- Cardiovascular Institute, Stanford University, Stanford, CA, 94305, USA.
| | - Adam Gross
- Albany Medical College, Albany, NY, 12208, USA
| | - Roy O Mathew
- Department of Medicine, Loma Linda VA Health Care System, Loma Linda, CA, 92357, USA
| | - Loay Salman
- Division of Nephrology, Department of Medicine, Albany Medical College, Albany, NY, 12208, USA
| | - Sushma Reddy
- Cardiovascular Institute, Stanford University, Stanford, CA, 94305, USA
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, CA, 94305, USA
| | - Edda Spiekerkoetter
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Stanford University, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA, 94305, USA
- Cardiovascular Institute, Stanford University, Stanford, CA, 94305, USA
| | - Mandeep S Sidhu
- Division of Cardiology, Department of Medicine, Department of Medical Education, Albany Medical College, Albany, NY, 12208, USA
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Kim JH, Baggish AL, Levine BD, Ackerman MJ, Day SM, Dineen EH, Guseh JS, La Gerche A, Lampert R, Martinez MW, Papadakis M, Phelan DM, Shafer KM. Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2025; 151:e716-e761. [PMID: 39973614 DOI: 10.1161/cir.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
COLLABORATORS Larry A. Allen, MD, MHS, FAHA, FACC; Mats Börjesson, MD, PhD, FACC; Alan C. Braverman, MD, FACC; Julie A. Brothers, MD; Silvia Castelletti, MD, MSc, FESC; Eugene H. Chung, MD, MPH, FHRS, FAHA, FACC; Timothy W. Churchill, MD, FACC; Guido Claessen, MD, PhD; Flavio D'Ascenzi, MD, PhD; Douglas Darden, MD; Peter N. Dean, MD, FACC; Neal W. Dickert, MD, PhD, FACC; Jonathan A. Drezner, MD; Katherine E. Economy, MD, MPH; Thijs M.H. Eijsvogels, PhD; Michael S. Emery, MD, MS, FACC; Susan P. Etheridge, MD, FHRS, FAHA, FACC; Sabiha Gati, BSc (Hons), MBBS, PhD, MRCP, FESC; Belinda Gray, BSc (Med), MBBS, PhD; Martin Halle, MD; Kimberly G. Harmon, MD; Jeffrey J. Hsu, MD, PhD, FAHA, FACC; Richard J. Kovacs, MD, FAHA, MACC; Sheela Krishnan, MD, FACC; Mark S. Link, MD, FHRS, FAHA, FACC; Martin Maron, MD; Silvana Molossi, MD, PhD, FACC; Antonio Pelliccia, MD; Jack C. Salerno, MD, FACC, FHRS; Ankit B. Shah, MD, MPH, FACC; Sanjay Sharma, BSc (Hons), MBChB, MRCP (UK), MD; Tamanna K. Singh, MD, FACC; Katie M. Stewart, NP, MS; Paul D. Thompson, MD, FAHA, FACC; Meagan M. Wasfy, MD, MPH, FACC; Matthias Wilhelm, MD. This American Heart Association/American College of Cardiology scientific statement on clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities or diseases is organized into 11 distinct sections focused on sports-specific topics or disease processes that are relevant when considering the potential risks of adverse cardiovascular events, including sudden cardiac arrest, during competitive sports participation. Task forces comprising international experts in sports cardiology and the respective topics covered were assigned to each section and prepared specific clinical considerations tables for practitioners to reference. Comprehensive literature review and an emphasis on shared decision-making were integral in the writing of all clinical considerations presented.
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Kim JH, Baggish AL, Levine BD, Ackerman MJ, Day SM, Dineen EH, Guseh Ii JS, La Gerche A, Lampert R, Martinez MW, Papadakis M, Phelan DM, Shafer KM, Allen LA, Börjesson M, Braverman AC, Brothers JA, Castelletti S, Chung EH, Churchill TW, Claessen G, D'Ascenzi F, Darden D, Dean PN, Dickert NW, Drezner JA, Economy KE, Eijsvogels TMH, Emery MS, Etheridge SP, Gati S, Gray B, Halle M, Harmon KG, Hsu JJ, Kovacs RJ, Krishnan S, Link MS, Maron M, Molossi S, Pelliccia A, Salerno JC, Shah AB, Sharma S, Singh TK, Stewart KM, Thompson PD, Wasfy MM, Wilhelm M. Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2025; 85:1059-1108. [PMID: 39976316 DOI: 10.1016/j.jacc.2024.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
This American Heart Association/American College of Cardiology scientific statement on clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities or diseases is organized into 11 distinct sections focused on sports-specific topics or disease processes that are relevant when considering the potential risks of adverse cardiovascular events, including sudden cardiac arrest, during competitive sports participation. Task forces comprising international experts in sports cardiology and the respective topics covered were assigned to each section and prepared specific clinical considerations tables for practitioners to reference. Comprehensive literature review and an emphasis on shared decision-making were integral in the writing of all clinical considerations presented.
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Mok Y, Ballew SH, Schrack JA, Howard CM, Butler KR, Wagenknecht L, Coresh J, Budoff M, Tanaka H, Blaha MJ, Matsushita K. Mid-life physical activity and calcification of coronary arteries, aorta, and cardiac valves in late life: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2025; 402:119115. [PMID: 39922082 PMCID: PMC11890941 DOI: 10.1016/j.atherosclerosis.2025.119115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/20/2024] [Accepted: 01/26/2025] [Indexed: 02/10/2025]
Abstract
BACKGROUND AND AIMS The association of physical activity (PA) with coronary artery calcification (CAC), one of the strongest predictors of cardiovascular disease, is unclear. Moreover, different domains of PA (e.g., exercise/sports vs. work) and extra-coronary calcification (ECC) have not been extensively studied. We comprehensively evaluated the association of PA with CAC and ECC. METHODS We investigated 2025 ARIC participants (age 73-95 years) without coronary heart disease at visit 7 (2018-19). Mid-life total and domain-specific (sport, leisure, and work) PA scores were estimated using a modified Baecke questionnaire. We modeled the averaged PA scores at visit 1 (1987-89; age 44-65 years) and visit 3 (1993-95; age 49-70 years). We explored continuous CAC and ECC (log-transformed [Agatston score+1]) or the presence of any CAC and ECC (Agatston score >0 vs. 0) as dependent variables using multivariable linear regression and logistic regression models, as appropriate. RESULTS Total PA scores showed a U-shaped association with both continuous and any vs. no CAC. Higher total PA scores were associated inversely with ECC and most pronounced for the descending aorta calcification. The associations were generally consistent across demographic subgroups. When specific PA domains were examined, higher sport and work PA scores were significantly associated with lower descending aorta calcification. CONCLUSIONS Mid-life PA showed a U-shaped association with late-life CAC. Among ECC, the association of higher PA with lower calcification of the descending aorta was the most consistent. Our results further corroborate a complex interplay between PA and vascular health and unique pathological processes across different vascular beds.
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Affiliation(s)
- Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shoshana H Ballew
- Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Lynne Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Josef Coresh
- Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Matthew Budoff
- Endowed Chair of Preventive Cardiology, Lundquist Institute, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Rajiah PS, Kumar V, Domenech-Ximenos B, Francone M, Broncano J, Allison TG. Utility of MRI and CT in Sports Cardiology. Radiographics 2025; 45:e240045. [PMID: 40014471 DOI: 10.1148/rg.240045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2025]
Abstract
Sports cardiologists specialize in the care of competitive athletes and highly active people by detecting and managing cardiovascular diseases that can impact sports participation and counseling on return to sports after cardiovascular events. Preparticipation evaluation of athletes includes history, physical examination, and electrocardiography (ECG), with exercise ECG added when screening master athletes. If the findings are abnormal or inconclusive, echocardiography is used for further evaluation. Further imaging with MRI, CT, or stress test is performed for establishing a diagnosis when echocardiography is indeterminate or discordant with clinical features and for risk stratification if echocardiography provides a definitive diagnosis. MRI can help distinguish athlete's heart from similar-appearing pathologic entities when echocardiography is inconclusive. Athlete's heart can manifest as left ventricular hypertrophy (LVH), left ventricle (LV) dilatation, prominent LV trabeculations, and right ventricular (RV) dilatation. Adaptive LVH in athletes is concentric and typically measures less than 16 mm, which distinguishes it from pathologic LV thickening of hypertrophic cardiomyopathy, hypertension, valvular disease, and infiltrative cardiomyopathies. Adaptive LV dilatation with normal or mildly reduced ejection fraction can be seen in endurance athletes. LV ejection fraction greater than 40%, augmentation of LV ejection fraction with exercise, and normal or supranormal diastolic function distinguishes it from dilated cardiomyopathy. Physiologic RV dilatation in athletes is distinguished from arrhythmogenic cardiomyopathy (RV type) by global involvement and absence of major regional wall motion abnormalities or late gadolinium enhancement. MRI is also useful in diagnosis and risk stratification of athletes with cardiovascular symptoms and after major cardiovascular events such as arrhythmias, myocardial infarction, and resuscitated sudden cardiac death or arrest. CT angiography provides accurate evaluation of coronary artery anomalies and coronary artery disease. ©RSNA, 2025 Supplemental material is available for this article.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Departments of Radiology (P.S.R.) and Cardiology (V.K., T.G.A.), Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X); Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini Pieve Emanuele (Milan) Italy and RCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.F.); and Cardiothoracic Imaging Unit, HT Médica, Hospital San Juan de Dios, Córdoba, Spain (J.B.)
| | - Vinayak Kumar
- From the Departments of Radiology (P.S.R.) and Cardiology (V.K., T.G.A.), Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X); Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini Pieve Emanuele (Milan) Italy and RCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.F.); and Cardiothoracic Imaging Unit, HT Médica, Hospital San Juan de Dios, Córdoba, Spain (J.B.)
| | - Blanca Domenech-Ximenos
- From the Departments of Radiology (P.S.R.) and Cardiology (V.K., T.G.A.), Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X); Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini Pieve Emanuele (Milan) Italy and RCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.F.); and Cardiothoracic Imaging Unit, HT Médica, Hospital San Juan de Dios, Córdoba, Spain (J.B.)
| | - Marco Francone
- From the Departments of Radiology (P.S.R.) and Cardiology (V.K., T.G.A.), Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X); Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini Pieve Emanuele (Milan) Italy and RCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.F.); and Cardiothoracic Imaging Unit, HT Médica, Hospital San Juan de Dios, Córdoba, Spain (J.B.)
| | - Jordi Broncano
- From the Departments of Radiology (P.S.R.) and Cardiology (V.K., T.G.A.), Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X); Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini Pieve Emanuele (Milan) Italy and RCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.F.); and Cardiothoracic Imaging Unit, HT Médica, Hospital San Juan de Dios, Córdoba, Spain (J.B.)
| | - Thomas G Allison
- From the Departments of Radiology (P.S.R.) and Cardiology (V.K., T.G.A.), Mayo Clinic, 200 1st Street SW, Rochester, MN 55905; Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X); Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini Pieve Emanuele (Milan) Italy and RCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.F.); and Cardiothoracic Imaging Unit, HT Médica, Hospital San Juan de Dios, Córdoba, Spain (J.B.)
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Braschler L, Nikolaidis PT, Thuany M, Chlíbková D, Rosemann T, Weiss K, Wilhelm M, Knechtle B. Physiology and Pathophysiology of Marathon Running: A narrative Review. SPORTS MEDICINE - OPEN 2025; 11:10. [PMID: 39871014 PMCID: PMC11772678 DOI: 10.1186/s40798-025-00810-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 12/30/2024] [Indexed: 01/29/2025]
Abstract
BACKGROUND Marathon training and running have many beneficial effects on human health and physical fitness; however, they also pose risks. To date, no comprehensive review regarding both the benefits and risks of marathon running on different organ systems has been published. MAIN BODY The aim of this review was to provide a comprehensive review of the benefits and risks of marathon training and racing on different organ systems. A predefined search strategy including keywords (e.g., marathon, cardiovascular system, etc.) and free text search was used. Articles covering running regardless of sex, age, performance level, and event type (e.g., road races, mountain marathons) were considered, whereas articles examining only cycling, triathlon, stress-tests or other sports were excluded. In total, we found 1021 articles in PubMed, Scopus, and Google Scholar, of which 329 studies were included in this review. Overall, marathon training offers several benefits for different organ systems and reduces all-cause mortality. As such, it improves cardiovascular risk factors, leads to favorable cardiac adaptations, enhances lung function, and improves quality of life in chronic kidney disease patients. It also enhances gastrointestinal mobility and reduces the risk of specific tumors such as colorectal cancer and hepatocellular carcinoma. Marathon training enhances bone health and skeletal muscle metabolism. It further positively affects hematopoiesis and cytotoxic abilities of natural killer cells, and may act neuroprotective on a long-term basis. After a marathon, changes in biomarkers suggesting pathological events in certain organ systems such as cardiovascular, renal, gastrointestinal, liver, hematological, immune, musculoskeletal, central nervous, and endocrine systems can often be observed. Mostly, these changes are limited to 1-3 days post-race and usually normalize within a week. Moreover, marathon running poses the risk of serious adverse events such as sudden cardiac death or acute liver failure. Concerning lung function, a decrease after a marathon race was observed. Acute kidney injury, as well as electrolyte imbalances, are relatively common amongst marathon finishers. Many runners complain of gastrointestinal symptoms during or after long-distance running. Many runners suffer from running-related musculoskeletal injuries often impairing performance. A marathon is often accompanied by an acute inflammatory response with transient immunosuppression, making runners susceptible to infections. Also, hormonal alterations such as increased cortisol levels or decreased testosterone levels immediately after a race are observed. Disturbances in sleep patterns are commonly found in marathon runners leading up to or directly after the race. CONCLUSION All in all, marathon training is generally safe for human health and individual organ systems. Considering the high popularity of marathon running, these findings supply athletes, coaches, sports scientists, and sports medicine practitioners with practical applications. Further large-scale studies examining long-term effects on the cardiovascular, renal, and other system are needed.
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Affiliation(s)
- Lorin Braschler
- Centre for Rehabilitation and Sports Medicine, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | | | - Mabliny Thuany
- Department of Physical Education, State University of Para, Pará, Brazil
| | - Daniela Chlíbková
- Brno University of Technology, Centre of Sport Activities, Brno, Czechia
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation and Sports Medicine, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
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10
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Deng Y, Tang M, Liu Q, Fan X, Shu J, Chen J, Chen M, Yang L. Prediction of cardiac remodeling and myocardial fibrosis in athletes based on IVIM-DWI images. iScience 2025; 28:111567. [PMID: 39829680 PMCID: PMC11742616 DOI: 10.1016/j.isci.2024.111567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 09/29/2024] [Accepted: 12/06/2024] [Indexed: 01/22/2025] Open
Abstract
Myocardial microcirculation in athletes and its relationship with cardiac remodeling (CR) and myocardial fibrosis (MF) are not fully understood. We prospectively enrolled 174 athletes and 54 healthy sedentary controls for intravoxel incoherent motion (IVIM) diffusion-weighted imaging of cardiac magnetic resonance imaging. Athletes exhibited significantly lower fast apparent diffusion coefficient (ADCfast) and perfusion fraction (f) in 16 myocardial segments and each blood supply area compared to controls (p < 0.05). Athletes with CR and/or MF had lower myocardial slow apparent diffusion coefficient (ADCslow) values than those without (p < 0.05). A gradient boosting machine (GBM) effectively predicted CR and/or MF based on these hypoperfusion parameters, with an area under the receiver operating characteristic curve of 0.947 in the training set and 0.841 in the test set. The GBM model, leveraging IVIM parameters, could predict the occurrence of CR and/or MF, offering a potential tool for monitoring and managing the athletes' health.
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Affiliation(s)
- Yujiao Deng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25# Tai Ping Street, Luzhou, Sichuan 646000, China
- Department of Nuclear Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32#, West Second Section of First Ring Road, Chengdu, Sichuan 610000, China
| | - Min Tang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25# Tai Ping Street, Luzhou, Sichuan 646000, China
| | - Qian Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25# Tai Ping Street, Luzhou, Sichuan 646000, China
| | - Xinrong Fan
- Department of Cardiology, the Affiliated Hospital of Southwest Medical University, 25# Tai Ping Street, Luzhou, Sichuan 646000, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25# Tai Ping Street, Luzhou, Sichuan 646000, China
| | - Jing Chen
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25# Tai Ping Street, Luzhou, Sichuan 646000, China
| | - Meining Chen
- MR Research Collaboration, Siemens Healthineers Ltd., Chengdu, China
| | - Lu Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25# Tai Ping Street, Luzhou, Sichuan 646000, China
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11
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Guo C, Zhang H, Yang C, Hu P, Ma H, Ma Y, Gao F. Right ventricular function in athletes engaged in endurance exercise using speckle tracking echocardiography: a meta-analysis. BMC Cardiovasc Disord 2025; 25:6. [PMID: 39762759 PMCID: PMC11702120 DOI: 10.1186/s12872-024-04455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/26/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Long-term endurance training is associated with structural, functional, and biochemical markers of cardiac dysfunction in highly trained athletes. Many studies have focused on structural changes in the right ventricle (RV) and few have examined functional adaptation of the right ventricle. This meta-analysis aims to compare the changes in right ventricular systolic function between endurance athletes and controls before and after exercise using speckle tracking echocardiography (STE). METHODS A comprehensive search of relevant studies published before March 19, 2024 that examined RV systolic function using speckle tracking technology was conducted. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used as pooled statistics. Meta regression was employed to identify sources of heterogeneity and publication bias was evaluated by Egger's test and funnel plots. Sensitivity analysis was performed by removing sources of significant change from the results of a single publication to evaluate the stability of the results. RESULTS Twenty studies were included with 1186 participants. A fixed effect meta-analysis revealed RV global longitudinal strain (GLS) WMD = 0.40, 95% CI (-0.08 ~ 0.89), p = 0.102 and free wall longitudinal strain (FWLS) WMD = 0.62, 95% CI (0.28 ~ 0.96), p < 0.001, random effect models of RV basal strain WMD = 2.94, 95% CI (2.00 ~ 3.88), p < 0.001 and RV apical strain WMD = -0.79, 95% CI (-1.95, 0.37), p = 0.245 between endurance athletes and controls. In addition, a random-effects meta-analysis revealed significant impairments in RV function when assessed by comparing RV GLS pre-endurance versus post endurance exercise WMD = 2.51, 95% CI (1.634 ~ 3.40), p < 0. 001. CONCLUSION The evidence obtained thus far suggests that reporting only global right ventricular strain data may obscure segment-specific adaptation changes, and the use of global and segmental strain analysis may help to identify potential functional changes in the right ventricle while differentiating between normal endurance athletes and non-active controls.
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Affiliation(s)
- Chenzan Guo
- Department of Ultrasonography, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Hebin Zhang
- Department of Ultrasonography, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Hangzhou Institute of Sports Medicine for Marathon, Hangzhou, China
| | - Cunxin Yang
- Department of Ultrasonography, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Peipei Hu
- Department of Ultrasonography, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Hui Ma
- Department of Ultrasonography, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Ying Ma
- Department of Ultrasonography, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Feng Gao
- Department of Ultrasonography, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
- Hangzhou Institute of Sports Medicine for Marathon, Hangzhou, China.
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12
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Rudofker E, Ochten NV, Edward J, Parker H, Wulff K, Suckow E, Forbes L, Cornwell WK. Exercise Testing in Elite Athletes. Heart Fail Clin 2025; 21:15-25. [PMID: 39550077 DOI: 10.1016/j.hfc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2024]
Abstract
Exercise testing is frequently incorporated into management of patients with cardiovascular and/or pulmonary disease. A lifelong commitment to exercise promotes cardiac remodeling, leading to changes in structure and function of the atria and ventricles, commonly referred to as the "athletic heart." Stress testing is also incorporated into the management of athletes for a variety of reasons, such as identifying the cause of exertional symptoms, determining level of fitness and training zones, or assessing for acquired cardiomyopathies. Exercise testing should be tailored to the athlete, since performance may vary from other populations as a result of a commitment to exercise training.
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Affiliation(s)
- Eric Rudofker
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora 80045, USA
| | - Natalie Van Ochten
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora 80045, USA
| | - Justin Edward
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora 80045, USA; Department of Cardiology, Kaiser Permanente, 2045 Franklin Street, # 200, Denver, CO 80205, USA
| | - Hugh Parker
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora 80045, USA
| | - Kyla Wulff
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, 12401 East 17th Avenue Leprino Building, Aurora, CO, USA
| | - Emmett Suckow
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora 80045, USA
| | - Lindsey Forbes
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora 80045, USA
| | - William K Cornwell
- Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora 80045, USA; Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, 12401 East 17th Avenue Leprino Building, Aurora, CO, USA.
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13
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Celeski M, Segreti A, Crisci F, Cricco R, Piscione M, Di Gioia G, Nusca A, Fossati C, Pigozzi F, Ussia GP, Solaro RJ, Grigioni F. The Role of Cardiac Troponin and Other Emerging Biomarkers Among Athletes and Beyond: Underlying Mechanisms, Differential Diagnosis, and Guide for Interpretation. Biomolecules 2024; 14:1630. [PMID: 39766337 PMCID: PMC11727179 DOI: 10.3390/biom14121630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 12/11/2024] [Accepted: 12/17/2024] [Indexed: 01/15/2025] Open
Abstract
Cardiovascular (CV) disease remains the leading cause of morbidity and mortality worldwide, highlighting the necessity of understanding its underlying molecular and pathophysiological pathways. Conversely, physical activity (PA) and exercise are key strategies in reducing CV event risks. Detecting latent CV conditions in apparently healthy individuals, such as athletes, presents a unique challenge. The early identification and treatment of CV disorders are vital for long-term health and patient survival. Cardiac troponin is currently the most commonly used biomarker for assessing CV changes in both athletes and the general population. However, there remains considerable debate surrounding the mechanisms underlying exercise-induced troponin elevations and its release in non-ischemic contexts. Thus, there is a pressing need to identify and implement more sensitive and specific biomarkers for CV disorders in clinical practice. Indeed, research continues to explore reliable biomarkers for evaluating the health of athletes and the effectiveness of physical exercise. It is essential to analyze current evidence on troponin release in non-ischemic conditions, post-strenuous exercise, and the complex biological pathways that influence its detection. Furthermore, this study summarizes current research on cytokines and exosomes, including their physiological roles and their relevance in various CV conditions, especially in athletes. In addition, this paper gives special attention to underlying mechanisms, potential biomarkers, and future perspectives.
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Affiliation(s)
- Mihail Celeski
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Andrea Segreti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis 6, 00135 Roma, Italy
| | - Filippo Crisci
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Riccardo Cricco
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Mariagrazia Piscione
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Giuseppe Di Gioia
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis 6, 00135 Roma, Italy
- Institute of Sports Medicine and Science, Italian National Olympic Committee, Largo Piero Gabrielli 1, 00197 Roma, Italy
| | - Annunziata Nusca
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis 6, 00135 Roma, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis 6, 00135 Roma, Italy
| | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Ross John Solaro
- Department of Physiology and Biophysics and Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy (R.C.)
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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14
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D’Ambrosio P, Claessen G, Kistler PM, Heidbuchel H, Kalman JM, La Gerche A. Ventricular arrhythmias in association with athletic cardiac remodelling. Europace 2024; 26:euae279. [PMID: 39499658 PMCID: PMC11641426 DOI: 10.1093/europace/euae279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 10/04/2024] [Accepted: 10/28/2024] [Indexed: 11/07/2024] Open
Abstract
Athletes are predisposed to atrial arrhythmias but the association between intense endurance exercise training, ventricular arrhythmias (VAs), and sudden cardiac death is less well established. Thus, it is unclear whether the 'athlete's heart' promotes specific arrhythmias or whether it represents a more general pro-arrhythmogenic phenotype. Whilst direct causality has not been established, it appears possible that repeated exposure to high-intensity endurance exercise in some athletes contributes to formation of pro-arrhythmic cardiac phenotypes that underlie VAs. Theories regarding potential mechanisms for exercise-induced VAs include repeated bouts of myocardial inflammation and stretch-induced cellular remodelling. Small animal models provide some insights, but larger animal and human data are sparse. The current clinical approach to VAs in athletes is to differentiate those with and without structural or electrical heart disease. However, if the athlete's heart involves a degree of pro-arrhythmogenic remodelling, then this may not be such a simple dichotomy. Questions are posed by athletes with VAs in combination with extreme remodelling. Some markers, such as scar on magnetic resonance imaging, may point towards a less benign phenotype but are also quite common in ostensibly healthy athletes. Other clinical and invasive electrophysiology features may be helpful in identifying the at-risk athlete. This review seeks to discuss the association between athletic training and VAs. We will discuss the potential mechanisms, clinical significance, and approach to the management of athletes with VAs.
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MESH Headings
- Humans
- Ventricular Remodeling
- Athletes
- Cardiomegaly, Exercise-Induced
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Animals
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/etiology
- Risk Factors
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/diagnosis
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Affiliation(s)
- Paolo D’Ambrosio
- Department of Medicine, The University of Melbourne, Grattan St, Parkville, VIC 3010, Australia
- Heart Exercise & Research Trials (HEART) Lab, St Vincent’s Institute, 9 Princes St, Fitzroy, VIC 3065, Australia
- Department of Cardiology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3052, Australia
| | - Guido Claessen
- Faculty of Medicine and Life Sciences, LCRC, UHasselt, Biomedical Research Institute, Diepenbeek, Belgium
- Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Peter M Kistler
- Department of Medicine, The University of Melbourne, Grattan St, Parkville, VIC 3010, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Clayton, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Jonathan M Kalman
- Department of Medicine, The University of Melbourne, Grattan St, Parkville, VIC 3010, Australia
- Department of Cardiology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3052, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne, Grattan St, Parkville, VIC 3010, Australia
- Heart Exercise & Research Trials (HEART) Lab, St Vincent’s Institute, 9 Princes St, Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital, Fitzroy, VIC, Australia
- HEART Lab, Victor Chang Cardiovascular Research Institute, Darlinghurst, NSW, Australia
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15
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Donaldson JA, Wiles JD, Papadakis M, Sharma S, Sharma R, O'Driscoll JM. Olympic distance duathlon and cardiac performance in highly-trained triathletes. Physiol Rep 2024; 12:e70154. [PMID: 39725671 DOI: 10.14814/phy2.70154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 11/28/2024] [Accepted: 11/29/2024] [Indexed: 12/28/2024] Open
Abstract
The effects of triathlon exercise on cardiac function are well documented. While Olympic triathlon (swim-bike-run) remains the standard format, increasing concerns about water quality in natural waterways present ongoing challenges for open-water swimming events, highlighting the potential need to consider alternative formats such as duathlon (run-bike-run) in some circumstances. An additional run may increase the overall metabolic and cardiovascular demand compared with the swim in triathlon, leading to reduced future performance. Conversely, the majority of EICF research reports reversal of post-exercise perturbations within 24-7 days of recovery but duathlon has not yet been studied in this context. Therefore, this study aimed to investigate the cardiac, autonomic, haemodynamic and biomarker responses during and following two Olympic distance (OD) duathlon separated by 7 days of recovery. Highly-trained (V O2max >60 mL·kg-1·min-1) male participants (n = 10) completed two lab-based OD duathlons, either continuous (BD) or with functional measurements after each leg (UD), separated by 7 days of rest. Conventional echocardiography recorded standard and tissue Doppler measures of left ventricular (LV) structure and function. Speckle tracking echocardiography was used to measure global longitudinal strain (GLS). Time and frequency domain analysis of HRV, as well as plasma high sensitivity cardiac troponin T (hs-cTnT) were measured pre and post exercise. In the broken duathlon trial (BD) cardiac measurements and blood samples were also taken between each leg. In the unbroken duathlon (UD) participants performed each leg sequentially. Duathlon exercise resulted in similar cardiac functional and biomarker alterations as previously reported in triathlon and standalone running and cycling exercise. Cardiac troponins were still elevated following 24 h-1 of recovery. However, functional changes were resolved within 24 h-1 of passive recovery and did not impair subsequent duathlon performance, or pre-exercise measurements 7 days after the first trial. Whether or not elite or recreational athletes experience the same magnitude and reversibility of these changes remains to be elucidated further.
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Affiliation(s)
- J A Donaldson
- Department of Cardiovascular Sciences, College of Life Sciences, Cardiovascular Research Science, Glenfield Hospital, Leicester, UK
| | - J D Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - M Papadakis
- Cardiology Clinical Academic Group, St George's, University of London, London, UK
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Sharma
- Cardiology Clinical Academic Group, St George's, University of London, London, UK
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - R Sharma
- Cardiology Clinical Academic Group, St George's, University of London, London, UK
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J M O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
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16
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Forbes LM, Bull TM, Lahm T, Sisson T, O’Gean K, Lawley JS, Hunter K, Levine BD, Lovering A, Roach RC, Subudhi AW, Cornwell WK. Right ventricular performance during acute hypoxic exercise. J Physiol 2024; 602:5523-5537. [PMID: 38409819 PMCID: PMC11345882 DOI: 10.1113/jp284943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
Acute hypoxia increases pulmonary arterial (PA) pressures, though its effect on right ventricular (RV) function is controversial. The objective of this study was to characterize exertional RV performance during acute hypoxia. Ten healthy participants (34 ± 10 years, 7 males) completed three visits: visits 1 and 2 included non-invasive normoxic (fraction of inspired oxygen (F i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) = 0.21) and isobaric hypoxic (F i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ = 0.12) cardiopulmonary exercise testing (CPET) to determine normoxic/hypoxic maximal oxygen uptake (V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ ). Visit 3 involved invasive haemodynamic assessments where participants were randomized 1:1 to either Swan-Ganz or conductance catheterization to quantify RV performance via pressure-volume analysis. Arterial oxygen saturation was determined by blood gas analysis from radial arterial catheterization. During visit 3, participants completed invasive submaximal CPET testing at 50% normoxicV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ and again at 50% hypoxicV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ (F i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ = 0.12). Median (interquartile range) values for non-invasiveV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ values during normoxic and hypoxic testing were 2.98 (2.43, 3.66) l/min and 1.84 (1.62, 2.25) l/min, respectively (P < 0.0001). Mean PA pressure increased significantly when transitioning from rest to submaximal exercise during normoxic and hypoxic conditions (P = 0.0014). Metrics of RV contractility including preload recruitable stroke work, dP/dtmax, and end-systolic pressure increased significantly during the transition from rest to exercise under normoxic and hypoxic conditions. Ventricular-arterial coupling was maintained during normoxic exercise at 50%V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ . During submaximal exercise at 50% of hypoxicV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ , ventricular-arterial coupling declined but remained within normal limits. In conclusion, resting and exertional RV functions are preserved in response to acute exposure to hypoxia at anF i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ = 0.12 and the associated increase in PA pressures. KEY POINTS: The healthy right ventricle augments contractility, lusitropy and energetics during periods of increased metabolic demand (e.g. exercise) in acute hypoxic conditions. During submaximal exercise, ventricular-arterial coupling decreases but remains within normal limits, ensuring that cardiac output and systemic perfusion are maintained. These data describe right ventricular physiological responses during submaximal exercise under conditions of acute hypoxia, such as occurs during exposure to high altitude and/or acute hypoxic respiratory failure.
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Affiliation(s)
- Lindsay M. Forbes
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States
| | - Todd M. Bull
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States
| | - Tim Lahm
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, United States
| | - Tyler Sisson
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora CO
| | - Katie O’Gean
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora CO
| | - Justin S. Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Kendall Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora CO
| | - Benjamin D. Levine
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
- Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, Dallas TX
| | | | - Robert C. Roach
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States
| | - Andrew W. Subudhi
- Department of Physiology, University of Colorado, Colorado Springs, Colorado, United States
| | - William K. Cornwell
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora CO
- Division of Cardiology, Department of Medicine. University of Colorado, Aurora, Colorado, United States
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17
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Maleki F, Mehrabani J. Right ventricular remodeling induced by prolonged excessive endurance exercise is mediated by upregulating Wnt/β-catenin signaling in rats. Int J Cardiol 2024; 413:132316. [PMID: 38977222 DOI: 10.1016/j.ijcard.2024.132316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/26/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The aim of this study was to develop an animal model to investigate whether prolonged intensive endurance exercise induces RV remodeling, taking into account the involvement of Wnt/β-catenin signaling. METHODS Four-week-old male Wistar rats (100 to 125 g) were assigned to four groups (n = 8/group): 1) sixteen weeks of intensive (36 m/min) exercise (INT), 2) twelve weeks of the intensive exercise followed by four weeks of moderate intensity (18 m/min) exercise (INT + MOD), 3) twelve weeks of the intensive exercise followed by four weeks of detraining (INT + DT), and 4) sedentary rats (SED). The exercise protocols were performed five days a week for one h/day. Echocardiography, real-time PCR, western blotting, and histological staining were performed at the end of week sixteen. RESULTS INT rats developed concentric hypertrophy without diastolic dysfunction compared to SED (p = 0.006) and INT + DT (p = 0.035). Wnt1, β-catenin and CyclinD1 proteins in the training groups were significantly higher than SED rats (p < 0.001). Interestingly, INT rats had higher protein levels than INT + DT and INT + MOD (p < 0.001), with higher gene expression compared to SED rats (p < 0.05). There was also a significant increase in collagen deposition in INT rats compared to SED (p = 0.046) and INT + DT (p = 0.034). Furthermore, INT + MOD and INT + DT rats did not show any adverse structural, functional, or histological changes. CONCLUSIONS Long-term intensive endurance training seems to be associated with increased collagen deposition and wall thickness in the RV through Wnt/β-catenin signaling (which is concentration dependent), without changes in diastolic function. CLINICAL PERSPECTIVE Over the past decades, there has been an ongoing debate about whether the structural and functional adaptations of the cardiovascular system in trained endurance athletes are benign physiological responses to training or potentially pathological changes related to disease. While the adaptations of the left heart are well-documented, the remodeling of the right heart remains a subject of discussion. To gain insights into the ability of sustained high-intensity exercise to cause adverse right ventricular (RV) remodeling, we conducted an experimental study in which male rats were trained to run vigorously for 1 h daily over a 16-week period and compared them to a parallel group of sedentary control rats. Our findings revealed that intense long-term exercise induced morphological changes along with fibrosis affecting the RV. These fibrotic changes were a result of the 16-week vigorous exercise training regimen. If these results are confirmed in humans, they suggest that prolonged high-intensity endurance exercise training may lead to adverse cardiac remodeling. Our findings have important potential implications for the assessment of cardiac remodeling in individuals engaged in high-level exercise training.
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Affiliation(s)
- Farzaneh Maleki
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran.
| | - Javad Mehrabani
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran.
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18
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Fanale V, Segreti A, Fossati C, Di Gioia G, Coletti F, Crispino SP, Picarelli F, Antonelli Incalzi R, Papalia R, Pigozzi F, Grigioni F. Athlete's ECG Made Easy: A Practical Guide to Surviving Everyday Clinical Practice. J Cardiovasc Dev Dis 2024; 11:303. [PMID: 39452274 PMCID: PMC11508899 DOI: 10.3390/jcdd11100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/28/2024] [Accepted: 09/19/2024] [Indexed: 10/26/2024] Open
Abstract
Electrocardiogram modifications in athletes are common and usually reflect structural and electrical heart adaptations to regular physical training, known as the athlete's heart. However, these electrical modifications sometimes overlap with electrocardiogram findings that are characteristic of various heart diseases. A missed or incorrect diagnosis can significantly impact a young athlete's life and potentially have fatal consequences during exercise, such as sudden cardiac death, which is the leading cause of death in athletes. Therefore, it is crucial to correctly distinguish between expected exercise-related electrocardiogram changes in an athlete and several electrocardiogram abnormalities that may indicate underlying heart disease. This review aims to serve as a practical guide for cardiologists and sports clinicians, helping to define normal and physiology-induced electrocardiogram findings from those borderlines or pathological, and indicating when further investigations are necessary. Therefore, the possible athlete's electrocardiogram findings, including rhythm or myocardial adaptation, will be analyzed here, focusing mainly on the differentiation from pathological findings.
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Affiliation(s)
- Valerio Fanale
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Andrea Segreti
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 15, 00135 Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 15, 00135 Rome, Italy
| | - Giuseppe Di Gioia
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 15, 00135 Rome, Italy
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Federica Coletti
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Simone Pasquale Crispino
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Francesco Picarelli
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 15, 00135 Rome, Italy
| | - Francesco Grigioni
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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19
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Aaserud LT, Rootwelt-Norberg C, Five CK, Aabel EW, Hasselberg NE, Lyseggen E, Haugaa KH, Lie ØH. Progression of myocardial dysfunction and prediction of arrhythmic events in patients with exercise-induced arrhythmogenic cardiomyopathy. Heart Rhythm O2 2024; 5:705-712. [PMID: 39524050 PMCID: PMC11549643 DOI: 10.1016/j.hroo.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
Background Several reports exist of an acquired exercise-induced arrhythmogenic cardiomyopathy. Little is known about myocardial disease progression and arrhythmia prediction in this population. Objective The study sought to explore the evolution of myocardial function and structure and its relation to incident life-threatening ventricular arrhythmias (VA), to identify markers of impending events. Methods We included athletes (individuals with exercise doses >24 metabolic equivalent of task hours per week, >6 consecutive years, participating in organized and competitive sports) who had VA, absence of family history and known genetic variants associated with cardiac disease, and no other identified etiology, in a tertiary referral single-center, longitudinal cohort study of patients with exercise-induced arrhythmogenic cardiomyopathy (EiAC). Evolution of myocardial function and structure was assessed by repeated echocardiographic examinations during long-term follow-up. Life-threatening VA were assessed at baseline and during long-term follow-up. Results Forty-one EiAC patients (15% women, age 45 ± 13 years) were followed for 80 (interquartile range 48-115) months. There were no changes in myocardial function or structure in the overall population during follow-up. We observed high incidence rate and high recurrence rate of life-threatening VA in EiAC patients. Subtle deterioration of right ventricular function was strongly associated with subsequent first-time VA (odds ratio 1.12, 95% confidence interval 1.01-1.25, P = .031, per 1% deterioration of right ventricular free wall longitudinal strain). Conclusion There were no clear changes in myocardial function or structure during follow-up in the overall population, but there was a high incidence rate and high recurrence rate of life-threatening VA. Subtle right ventricular deterioration by free wall longitudinal strain was a strong predictor of impending first-time life-threatening VA during follow-up.
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Affiliation(s)
- Linda T. Aaserud
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christine Rootwelt-Norberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christian K. Five
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Eivind W. Aabel
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Nina E. Hasselberg
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik Lyseggen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kristina H. Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Øyvind H. Lie
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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20
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Kunutsor SK, Kurl S, Laukkanen JA. Cardiorespiratory fitness, atrial fibrillation and stroke: a review of the evidence in 2024. Expert Rev Cardiovasc Ther 2024; 22:493-508. [PMID: 39329169 DOI: 10.1080/14779072.2024.2409440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/15/2024] [Accepted: 09/23/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION The body of evidence linking cardiorespiratory fitness (CRF) levels with the risk of atrial fibrillation (AF) and stroke - two interconnected cardiovascular conditions - is not entirely consistent. Furthermore, specific CRF thresholds beyond which the risk of AF or stroke might not decrease are not well defined. AREAS COVERED This review summarizes research evidence on the role of CRF in the development of AF and stroke including dose-response relationships in general population participants, explores the biological mechanisms through which CRF may exert its effects, assesses the potential implications for clinical care and population health, identifies gaps in the current evidence, and suggest directions for future research. MEDLINE and Embase were searched from inception until July 2024 to identify observational longitudinal and interventional studies as well as systematic reviews and meta-analyses related to these study designs. EXPERT OPINION In the general population, increasing levels of CRF, achieved through consistent physical activity, can significantly reduce the likelihood of developing AF and stroke. The findings also advocate for a tailored approach to exercise prescriptions, acknowledging the plateau in benefits for AF risk beyond certain CRF levels, while advocating for higher intensity or prolonged activity to further reduce stroke risk.
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Affiliation(s)
- Setor K Kunutsor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Saint Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Brain Research Unit, Department of Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
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21
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Erevik CB, Kleiven Ø, Frøysa V, Bjørkavoll‐Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Exercise-Induced Cardiac Troponin I Elevation Is Associated With Regional Alterations in Left Ventricular Strain in High-Troponin Responders. J Am Heart Assoc 2024; 13:e034382. [PMID: 39158569 PMCID: PMC11963913 DOI: 10.1161/jaha.124.034382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/02/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The implications of exercise-induced cardiac troponin elevation in healthy individuals are unclear. This study aimed to determine if individuals with a high exercise-induced cardiac troponin I (cTnI) response have alterations in myocardial function following high-intensity endurance exercise compared with normal-cTnI responders. METHODS AND RESULTS Study individuals were recruited from previous participants in a 91-km mountain bike cycling race (the North Sea Race) and were classified as high- (n=34) or normal-cTnI responders (n=25) based on maximal cTnI values after the recruitment race. The present study exposed all participants to 2 prolonged high-intensity exercises: a combined lactate threshold and cardiopulmonary exercise test and repeated participation in the North Sea Race. Echocardiography was performed before, immediately after, and 24 hours following exercise. All study individuals (n=59) had normal coronary arteries, and were aged 51±10 years; 46 (74%) were men. There were no differences in baseline characteristics between the high- and normal-cTnI responders. Maximal cTnI levels 3 hours after exercise were significantly higher in the high- compared with normal-cTnI group (P<0.001-0.027). Following exercise, there were no differences in global ventricular function between the 2 groups. In contrast, high-cTnI responders had significantly lower regional strain in the anteroseptal segments following exercise, with more profound changes after the race. CONCLUSIONS High-cTnI responders had lower anteroseptal segmental strain shortly after exercise than normal-cTnI responders. However, there were no permanent alterations in myocardial strain, indicating no short- or long-term adverse consequences of these exercise-induced alterations in myocardial function. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02166216.
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Affiliation(s)
| | - Øyunn Kleiven
- Department of CardiologyStavanger University HospitalStavangerNorway
| | - Vidar Frøysa
- Department of CardiologyStavanger University HospitalStavangerNorway
| | | | - Monica Chivulescu
- ProCardio Center for Innovation, Department of CardiologyOslo University Hospital, RikshospitaletOsloNorway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of CardiologyOslo University Hospital, RikshospitaletOsloNorway
| | - Lars Dejgaard
- ProCardio Center for Innovation, Department of CardiologyOslo University Hospital, RikshospitaletOsloNorway
| | - Bjørn Auestad
- Department of Mathematics and PhysicsUniversity of StavangerStavangerNorway
- Research DepartmentStavanger University HospitalStavangerNorway
| | - Øyvind Skadberg
- Department of BiochemistryStavanger University HospitalStavangerNorway
| | - Tor Melberg
- Department of CardiologyStavanger University HospitalStavangerNorway
| | - Stig Urheim
- Department of CardiologyBergen University HospitalBergenNorway
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of CardiologyOslo University Hospital, RikshospitaletOsloNorway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of CardiologyOslo University Hospital, RikshospitaletOsloNorway
| | - Stein Ørn
- Department of CardiologyStavanger University HospitalStavangerNorway
- Department of Electrical Engineering and Computer ScienceUniversity of StavangerStavangerNorway
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22
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Allwood RP, Papadakis M, Androulakis E. Myocardial Fibrosis in Young and Veteran Athletes: Evidence from a Systematic Review of the Current Literature. J Clin Med 2024; 13:4536. [PMID: 39124802 PMCID: PMC11313657 DOI: 10.3390/jcm13154536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Exercise is associated with several cardiac adaptations that can enhance one's cardiac output and allow one to sustain a higher level of oxygen demand for prolonged periods. However, adverse cardiac remodelling, such as myocardial fibrosis, has been identified in athletes engaging in long-term endurance exercise. Cardiac magnetic resonance (CMR) imaging is considered the noninvasive gold standard for its detection and quantification. This review seeks to highlight factors that contribute to the development of myocardial fibrosis in athletes and provide insights into the assessment and interpretation of myocardial fibrosis in athletes. Methods: A literature search was performed using the PubMed/Medline database and Google Scholar for publications that assessed myocardial fibrosis in athletes using CMR. Results: A total of 21 studies involving 1642 endurance athletes were included in the analysis, and myocardial fibrosis was found in 378 of 1595 athletes. A higher prevalence was seen in athletes with cardiac remodelling compared to control subjects (23.7 vs. 3.3%, p < 0.001). Similarly, we found that young endurance athletes had a significantly higher prevalence than veteran athletes (27.7 vs. 19.9%, p < 0.001), while male and female athletes were similar (19.7 vs. 16.4%, p = 0.207). Major myocardial fibrosis (nonischaemic and ischaemic patterns) was predominately observed in veteran athletes, particularly in males and infrequently in young athletes. The right ventricular insertion point was the most common fibrosis location, occurring in the majority of female (96%) and young athletes (84%). Myocardial native T1 values were significantly lower in athletes at 1.5 T (p < 0.001) and 3 T (p = 0.004), although they had similar extracellular volume values to those of control groups. Conclusions: The development of myocardial fibrosis in athletes appears to be a multifactorial process, with genetics, hormones, the exercise dose, and an adverse cardiovascular risk profile playing key roles. Major myocardial fibrosis is not a benign finding and warrants a comprehensive evaluation and follow-up regarding potential cardiac disease.
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Affiliation(s)
- Richard P. Allwood
- Sports Cardiology Department, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George’s, University of London, London SW17 0RE, UK;
| | - Emmanuel Androulakis
- Cardiovascular Clinical Academic Group, St George’s, University of London, London SW17 0RE, UK;
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23
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Lima FVP, Andrade DDM, Filho JE, Souza PL, Azevedo LF, Coelho MM, de Lima JRP, Trevizan PF, Laterza MC, Martinez DG. Acute effect of ultramarathon on systolic and diastolic cardiac function: Systematic review and meta-analysis. Int J Cardiol 2024; 408:132106. [PMID: 38705202 DOI: 10.1016/j.ijcard.2024.132106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Ultramarathon running poses physiological challenges, impacting cardiac function. This systematic review and meta-analysis explore the acute effects of single-stage ultramarathon running on cardiac function. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were followed. Searches covered Medline, Embase, CINAHL, SPORTDiscus, Web of Science, Central Cochrane, and Scopus. Random effects meta-analyses assessed left ventricular (LV) and right ventricular (RV) variables, expressed as mean differences (MD) with 95% confidence intervals (CI). RESULTS Among 6972 studies, 17 were included. Post-ultramarathon reductions were found in LV end-diastolic diameter (LVEDD) (-1.24; 95% CI = -1.77, -0.71 mm), LV end-diastolic volume (LVEDV) (-9.92; 95% CI = -15.25, -4.60 ml), LV stroke volume (LVSV) (-8.96 ml, 95% CI -13.20, -4.72 ml), LV ejection fraction (LVEF) (-3.71; 95% CI = -5.21, -2.22%), LV global longitudinal strain (LVGLS) (-1.48; 95% CI = -2.21, -0.76%), E/A (-0.30; 95% CI = -0.38, -0.22 cm/s), .E' (-1.35 cm/s, 95% CI -1.91, -0.79 cm/s), RV fractional area change (RVFAC) (-3.34, 95% CI = -5.84, -0.84%), tricuspid annular plane systolic excursion (TAPSE) (-0.12, 95% CI = -0.22, -0.02 cm), RV global longitudinal strain (RVGLS) (-1.73, 95% CI = -2.87, -0.59%), with increases in RV end-diastolic area (RVEDA) (1.89, 95% CI = 0.63, 3.14 cm2), RV Peak A' (1.32 cm/s, 95% CI 0.20, 2.44), and heart rate (18.24, 95% CI = 15.16, 21.32). No significant differences were observed in LV end-systolic diameter (LVESD), LV end-systolic volume (LVESV), RV end-diastolic diameter (RVEDD), RV Peak E', and RV Peak S'. CONCLUSIONS Evidence suggests immediate impairment of systolic and diastolic cardiac function post-ultramarathon running.
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Affiliation(s)
- Francisco Veríssimo Perrout Lima
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil.
| | - Diana de Medeiros Andrade
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - José Elias Filho
- Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Pedro Lima Souza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Luciene Ferreira Azevedo
- Echocardiography Unit, University of São Paulo. Av. Dr. Enéas de Carvalho Aguiar, São Paulo, SP 44 - 05403-900, Brazil
| | - Marcelo Martins Coelho
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Jorge Roberto Perrout de Lima
- Faculty of Physical Education and Sports, Federal University of Juiz de Fora. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Patrícia Fernandes Trevizan
- Department of Physical Therapy, Federal University of Minas Gerais. Av. Presidente Carlos Luz, 6627 - Pampulha, Belo Horizonte, MG 31310-25, Brazil
| | - Mateus Camaroti Laterza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Daniel Godoy Martinez
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
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24
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Wang X, Li S, Xia C, Meng X, Li Y, Weng S, Xu T, Wang Y, Kong Y, Lang X, Guo Y, Wang F. Exercise-induced cardiac troponin elevations and cardiac ventricular dysfunction assessed by tissue Doppler echocardiography and speckle tracking among non-elite runners in Beijing marathon. J Sci Med Sport 2024; 27:508-514. [PMID: 38697867 DOI: 10.1016/j.jsams.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES We aimed to identify the major determinants of cardiac troponin changes response to exercise among non-elite runners participating in the Beijing 2022 marathon, with a particular focus on the associations with the cardiac function assessed by tissue Doppler echocardiography and speckle tracking. DESIGN A prospective study. METHODS A total of 33 non-elite participants in the 2022 Beijing Marathon were included in the study. Echocardiographic assessment and blood sample collection were conducted before, immediately after, and two weeks after the marathon. Blood samples were analyzed using the same Abbot high-sensitivity cTnI STAT assay. Echocardiography included tissue Doppler and speckle tracking echocardiography. RESULTS Following the marathon, significant increases were observed in cardiac biomarkers, with hs-cTnI elevating from 3.1 [2.3-6.7] to 49.6 [32.5-76.9] ng/L (P < 0.0001). Over 72 % of participants had post-race hs-TnI levels surpassing the 99th percentile upper reference limit. There was a notable correlation between pre-marathon hs-cTnI levels (β coefficient, 0.56 [0.05, 1.07]; P = 0.042), weekly average training (β coefficient, -1.15 [-1.95, -0.35]; P = 0.009), and hs-cTnI rise post-marathon. Echocardiography revealed significant post-race cardiac function changes, including decreased E/A ratio (P < 0.0001), GWI (P < 0.0001), and GCW (P < 0.0001), with LVEF (β coefficients, 0.112 [0.01, 0.21]; P = 0.042) and RV GLS (β coefficients, 0.124 [0.01, 0.23]; P = 0.035) changes significantly associated with hs-TnI alterations. All echocardiographic and laboratory indicators reverted to baseline levels within two weeks. CONCLUSIONS Baseline hs-cTnI levels and weekly average training influence exercise-induced hs-cTnI elevation in non-elite runners. Echocardiography revealed post-race changes in cardiac function, with LVEF and RV GLS significantly associated with hs-TnI alterations. These findings contribute to understanding the cardiac response to exercise and could guide training and recovery strategies.
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Affiliation(s)
- Xiang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Sidong Li
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chenxi Xia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Peking University Fifth School of Clinical Medicine, Beijing, PR China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Yi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Sixian Weng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Tao Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Yutong Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Yiya Kong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China
| | - Xiaotong Lang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, PR China; Peking University Fifth School of Clinical Medicine, Beijing, PR China; Chinese Academy of Medical Sciences and Peking Union Medical College, PR China; College of Life Science, University of Chinese Academy of Sciences, Beijing, China.
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25
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Nath LC, Saljic A, Buhl R, Elliott A, La Gerche A, Ye C, Schmidt Royal H, Lundgren Virklund K, Agbaedeng TA, Stent A, Franklin S. Histological evaluation of cardiac remodelling in equine athletes. Sci Rep 2024; 14:16709. [PMID: 39030282 PMCID: PMC11271503 DOI: 10.1038/s41598-024-67621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024] Open
Abstract
Approximately 1-2 per 100,000 young athletes die from sudden cardiac death (SCD) and extreme exercise may be associated with myocardial scar and arrhythmias. Racehorses have a high prevalence of atrial fibrillation (AF) and SCD but the presence of myocardial scar and inflammation has not been evaluated. Cardiac tissues from the left (LAA) and right (RAA) atrial appendages, left ventricular anterior (LVAPM) and posterior (LVPPM) papillary muscles, and right side of the interventricular septum (IVS-R) were harvested from racehorses with sudden cardiac death (SCD, n = 16) or other fatal injuries (OFI, n = 17), constituting the athletic group (ATH, n = 33), and compared to sedentary horses (SED, n = 10). Horses in the ATH group had myocyte hypertrophy at all sites; increased fibrosis at all sites other than the LAA; increased fibroblast infiltration but a reduction in the overall extracellular matrix (ECM) volume in the RAA, LVAPM, and IVS-R compared to SED horses. In this horse model, athletic conditioning was associated with myocyte hypertrophy and a reduction in ECM. There was an excess of fibrocyte infiltration and focal fibrosis that was not present in non-athletic horses, raising the possibility of an exercise-induced pro-fibrotic substrate.
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Affiliation(s)
- L C Nath
- University of Adelaide, Adelaide, Australia.
| | - A Saljic
- University of Copenhagen, Copenhagen, Denmark
| | - R Buhl
- University of Copenhagen, Copenhagen, Denmark
| | - A Elliott
- University of Adelaide, Adelaide, Australia
| | - A La Gerche
- St Vincents Institute Medical Research, Fitzroy, Australia
| | - C Ye
- University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - A Stent
- University of Melbourne, Parkville, Australia
| | - S Franklin
- University of Adelaide, Adelaide, Australia
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26
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Kerstens TP, Donker SC, Kleinnibbelink G, van Dijk AP, Oxborough D, Thijssen DHJ. Left and right ventricular strain-volume/area loops: a narrative review of current physiological understanding and potential clinical value. Echo Res Pract 2024; 11:12. [PMID: 38769555 PMCID: PMC11106969 DOI: 10.1186/s44156-024-00046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Traditionally, echocardiography is used for volumetric measurements to aid in assessment of cardiac function. Multiple echocardiographic-based assessment techniques have been developed, such as Doppler ultrasound and deformation imaging (e.g., peak global longitudinal strain (GLS)), which have shown to be clinically relevant. Volumetric changes across the cardiac cycle can be related to deformation, resulting in the Ventricular Strain-Volume/Area Loop. These Loops allow assessment of the dynamic relationship between longitudinal strain change and volumetric change across both systole and diastole. This integrated approach to both systolic and diastolic function assessment may offer additional information in conjunction with traditional, static, measures of cardiac function or structure. The aim of this review is to summarize our current understanding of the Ventricular Strain-Volume/Area Loop, describe how acute and chronic exposure to hemodynamic stimuli alter Loop characteristics, and, finally, to outline the potential clinical value of these Loops in patients with cardiovascular disease. In summary, several studies observed Loop changes in different hemodynamic loading conditions and various (patho)physiological conditions. The diagnostic and prognostic value, and physiological interpretation remain largely unclear and have been addressed only to a limited extent.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stijn Cm Donker
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Geert Kleinnibbelink
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - Arie Pj van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Research Institute for Sport and Exercise Medicine, Liverpool John Moores University, L3 5UX, Liverpool, United Kingdom.
- Department of Medical BioSciences (928), Radboud University Medical Center, 6500HB, Nijmegen, P.O. Box 9101, The Netherlands.
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27
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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 PMCID: PMC11380999 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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28
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Celeski M, Segreti A, Piscione M, Monticelli LM, Di Gioia G, Fossati C, Ussia GP, Pigozzi F, Grigioni F. The current paradigm of cardiac troponin increase among athletes. Monaldi Arch Chest Dis 2024. [PMID: 38700130 DOI: 10.4081/monaldi.2024.2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/16/2024] [Indexed: 05/05/2024] Open
Abstract
Although it is known that exercise improves cardiovascular health and extends life expectancy, a significant number of people may also experience an elevation in cardiac troponin levels as a result of exercise. For many years, researchers have argued whether exercise-induced cardiac troponin rises are a consequence of a physiological or pathological reaction and whether they are clinically significant. Differences in cardiac troponin elevation and cardiac remodeling can be seen between athletes participating in different types of sports. When forecasting the exercise-induced cardiac troponin rise, there are many additional parameters to consider, as there is a large amount of interindividual heterogeneity in the degree of cardiac troponin elevation. Although it was previously believed that cardiac troponin increases in athletes represented a benign phenomenon, numerous recent studies disproved this notion by demonstrating that, in specific individuals, cardiac troponin increases may have clinical and prognostic repercussions. This review aims to examine the role of cardiac troponin in athletes and its role in various sporting contexts. This review also discusses potential prognostic and clinical implications, as well as future research methods, and provides a straightforward step-by-step algorithm to help clinicians interpret cardiac troponin rise in athletes in both ischemic and non-ischemic circumstances.
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Affiliation(s)
- Mihail Celeski
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Andrea Segreti
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Mariagrazia Piscione
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Luigi Maria Monticelli
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Giuseppe Di Gioia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico"; Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome.
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico".
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome.
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29
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Cornwell WK, Levine BD. Unraveling the Unsolved Mysteries of the Athletic Heart. Circulation 2024; 149:1416-1418. [PMID: 38683901 DOI: 10.1161/circulationaha.124.064534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- William K Cornwell
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (W.K.C.)
- Clinical Translational Research Center, University of Colorado Anschutz Medical Center, Aurora, CO (W.K.C.)
| | - Benjamin D Levine
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (B.D.L.)
- Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, Dallas (B.D.L.)
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30
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Miljoen H, Favere K, Van De Heyning C, Corteville B, Dausin C, Herbots L, Teulingkx T, Bekhuis Y, Lyssens M, Bogaert J, Heidbuchel H, Claessen G. Low rates of myocardial fibrosis and ventricular arrhythmias in recreational athletes after SARS-CoV-2 infection. Front Cardiovasc Med 2024; 11:1372028. [PMID: 38628312 PMCID: PMC11018940 DOI: 10.3389/fcvm.2024.1372028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction High rates of cardiac involvement were reported in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. This led to anxiety in the athletic population. The current study was set up to assess the prevalence of myocardial fibrosis and ventricular arrhythmias in recreational athletes with the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Consecutive adult recreational athletes (≥18 years old, ≥4 h of mixed type or endurance sports/week) underwent systematic cardiac evaluation after a prior confirmed COVID-19 infection. Evaluation included clinical history, electrocardiogram (ECG), 5-day Holter monitoring, and cardiac magnetic resonance (CMR) imaging with simultaneous measurement of high-sensitive cardiac Troponin I. Data from asymptomatic or mildly symptomatic athletes (Group 1) were compared with those with moderate to severe symptoms (Groups 2-3). Furthermore, a comparison with a historical control group of athletes without COVID-19 (Master@Heart) was made. Results In total, 35 athletes (18 Group 1, 10 female, 36.9 ± 2.2 years, mean 143 ± 20 days following diagnosis) were evaluated. The baseline characteristics for the Group 1 and Groups 2-3 athletes were similar. None of the athletes showed overt myocarditis on CMR based on the updated Lake Louise criteria for diagnosis of myocarditis. The prevalence of non-ischemic late gadolinium enhancement [1 (6%) Group 1 vs. 2 (12%) Groups 2-3; p = 0.603] or ventricular arrhythmias [1 Group 1 athlete showed non-sustained ventricular tachycardia (vs. 0 in Groups 2-3: p = 1.000)] were not statistically different between the groups. When the male athletes were compared with the Master@Heart athletes, again no differences regarding these criteria were found. Conclusion In our series of recreational athletes with prior confirmed COVID-19, we found no evidence of ongoing myocarditis, and no more detection of fibrosis or ventricular arrhythmias than in a comparable athletic pre-COVID cohort. This points to a much lower cardiac involvement of COVID-19 in athletes than originally suggested.
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Affiliation(s)
- Hielko Miljoen
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Kasper Favere
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Caroline Van De Heyning
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
| | - Ben Corteville
- Department of Cardiology, Jan Palfijn Hospital, Ghent, Belgium
| | - Christophe Dausin
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Herbots
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Youri Bekhuis
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Leuven University Hospitals, Leuven, Belgium
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Malou Lyssens
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Guido Claessen
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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31
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Hastings MH, Castro C, Freeman R, Abdul Kadir A, Lerchenmüller C, Li H, Rhee J, Roh JD, Roh K, Singh AP, Wu C, Xia P, Zhou Q, Xiao J, Rosenzweig A. Intrinsic and Extrinsic Contributors to the Cardiac Benefits of Exercise. JACC Basic Transl Sci 2024; 9:535-552. [PMID: 38680954 PMCID: PMC11055208 DOI: 10.1016/j.jacbts.2023.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 05/01/2024]
Abstract
Among its many cardiovascular benefits, exercise training improves heart function and protects the heart against age-related decline, pathological stress, and injury. Here, we focus on cardiac benefits with an emphasis on more recent updates to our understanding. While the cardiomyocyte continues to play a central role as both a target and effector of exercise's benefits, there is a growing recognition of the important roles of other, noncardiomyocyte lineages and pathways, including some that lie outside the heart itself. We review what is known about mediators of exercise's benefits-both those intrinsic to the heart (at the level of cardiomyocytes, fibroblasts, or vascular cells) and those that are systemic (including metabolism, inflammation, the microbiome, and aging)-highlighting what is known about the molecular mechanisms responsible.
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Affiliation(s)
- Margaret H. Hastings
- Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Claire Castro
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Freeman
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Azrul Abdul Kadir
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolin Lerchenmüller
- Department of Cardiology, University Hospital Heidelberg, German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Haobo Li
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James Rhee
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason D. Roh
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kangsan Roh
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand P. Singh
- Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Chao Wu
- Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Peng Xia
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Qiulian Zhou
- Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Junjie Xiao
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, School of Life Science, Shanghai University, Shanghai, China
| | - Anthony Rosenzweig
- Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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32
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Andresen K, Klæboe LG, Lie ØH, Broch K, Kvaslerud AB, Bosse G, Hopp E, de Lange C, Haugaa KH, Edvardsen T. No adverse association between exercise exposure and diffuse myocardial fibrosis in male endurance athletes. Sci Rep 2024; 14:6581. [PMID: 38503845 PMCID: PMC10951320 DOI: 10.1038/s41598-024-57233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
The potential association between endurance exercise and myocardial fibrosis is controversial. Data on exercise exposure and diffuse myocardial fibrosis in endurance athletes are scarce and conflicting. We aimed to investigate the association between exercise exposure and markers of diffuse myocardial fibrosis by cardiovascular magnetic resonance imaging (CMR) in endurance athletes. We examined 27 healthy adult male competitive endurance athletes aged 41 ± 9 years and 16 healthy controls in a cross sectional study using 3 Tesla CMR including late gadolinium enhancement and T1 mapping. Athletes reported detailed exercise history from 12 years of age. Left ventricular total mass, cellular mass and extracellular mass were higher in athletes than controls (86 vs. 58 g/m2, 67 vs. 44 g/m2 and 19 vs. 13 g/m2, all p < 0.01). Extracellular volume (ECV) was lower (21.5% vs. 23.8%, p = 0.03) and native T1 time was shorter (1214 ms vs. 1268 ms, p < 0.01) in the athletes. Increasing exercise dose was independently associated with shorter native T1 time (regression coefficient - 24.1, p < 0.05), but expressed no association with ECV. Our results indicate that diffuse myocardial fibrosis has a low prevalence in healthy male endurance athletes and do not indicate an adverse dose-response relationship between exercise and diffuse myocardial fibrosis in healthy athletes.
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Affiliation(s)
- Kristoffer Andresen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Haugen Lie
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
| | - Kaspar Broch
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anette Borger Kvaslerud
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gerhard Bosse
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Charlotte de Lange
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Heart and Lung Diseases Unit, Department of Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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33
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Ramcharan T, Edwards J, O'Driscoll J, Papadakis M. The Acute Impact of Endurance Exercise on Right Ventricular Structure and Function: A Systematic Review and Meta-analysis. Card Electrophysiol Clin 2024; 16:25-34. [PMID: 38280812 DOI: 10.1016/j.ccep.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the right ventricle. This systematic review and meta-analysis summarizes and critiques 26 studies, including 649 athletes, examining the acute impact of endurance exercise on the right ventricle. We also present a subanalysis contrasting ultraendurance with endurance exercise. Finally, we identify areas for future research, such as the influence of sex, ethnicity, and age.
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Affiliation(s)
- Tristan Ramcharan
- Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom; MSc Sports Cardiology, St George's, University of London, London, United Kingdom
| | - Jamie Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent CT1 1QU, United Kingdom
| | - Jamie O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent CT1 1QU, United Kingdom.
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London, United Kingdom
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Javed W, Malhotra A, Swoboda P. Cardiac magnetic resonance assessment of athletic myocardial fibrosis; Benign bystander or malignant marker? Int J Cardiol 2024; 394:131382. [PMID: 37741350 DOI: 10.1016/j.ijcard.2023.131382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
The benefits of exercise are irrefutable with a well-established dose-dependent relationship between exercise intensity and reduction in cardiovascular disease. Differentiating the physiological adaptation to exercise, termed the "athlete's heart" from cardiomyopathies, has been advanced by the advent of more sophisticated imaging modalities such as cardiac magnetic resonance imaging (CMR). Myocardial fibrosis on CMR is a mutual finding amongst seemingly healthy endurance athletes and individuals with cardiomyopathy. As a substrate for arrhythmias, fibrosis is traditionally associated with increased cardiovascular risk. In this article, we discuss the aetiologies, distribution and potential implications of myocardial fibrosis in athletes.
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Affiliation(s)
- Wasim Javed
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Peter Swoboda
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Kunutsor SK, Laukkanen JA. Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: a narrative review. Expert Rev Cardiovasc Ther 2024; 22:91-101. [PMID: 38488568 PMCID: PMC11057847 DOI: 10.1080/14779072.2024.2328644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/06/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The evidence supporting the cardiovascular health benefits of physical activity and/or exercise training is well-established. While the role of physical activity in primary prevention is unequivocal, its significance in secondary prevention (among those with preexisting cardiovascular disease) is less definitive. Though guidelines universally recommend physical activity as part of the secondary preventive strategy, the empirical evidence underpinning these recommendations is not as robust as that for primary prevention. AREAS COVERED This review distills the body of available observational and interventional evidence on the relationship between physical activity, exercise, and adverse cardiovascular outcomes among those with preexisting cardiovascular disease. The postulated biologic mechanisms underlying the relationships, areas of prevailing uncertainty, and potential public health implications are also discussed. EXPERT OPINION A physical activity level of 500 MET-min/week (equivalent to 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity or an equivalent combination) may be a minimum requirement for patients with preexisting CVD. However, to reap the maximum benefits of physical activity and also minimize adverse effects, physical activity and/or exercise regimens should be tailored to unique factors such as individual's baseline physical activity habits, cardiovascular health status and the specific nature of their cardiovascular disease.
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Affiliation(s)
- Setor K. Kunutsor
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Jari A. Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Wellbeing Services County of Central Finland, Department of Medicine, Jyväskylä, Finland
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Lord RN, Adams ZH, George K, Somauroo J, Jones H, Oxborough D. Exploratory assessment of right ventricular structure and function during prolonged endurance cycling exercise. Echo Res Pract 2023; 10:22. [PMID: 38115147 PMCID: PMC10731767 DOI: 10.1186/s44156-023-00035-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/17/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND A reduction in right ventricular (RV) function during recovery from prolonged endurance exercise has been documented alongside RV dilatation. A relative elevation in pulmonary artery pressure and therefore RV afterload during exercise has been implicated in this post-exercise dysfunction but has not yet been demonstrated. The current study aimed to assess RV structure and function and pulmonary artery pressure before, during and after a 6-h cycling exercise bout. METHODS Eight ultra-endurance athletes were recruited for this study. Participants were assessed prior to exercise supine and seated, during exercise at 2, 4 and 6 h whilst cycling seated at 75% maximum heart rate, and post-exercise in the supine position. Standard 2D, Doppler and speckle tracking echocardiography were used to determine indices of RV size, systolic and diastolic function. RESULTS Heart rate and RV functional parameters increased from baseline during exercise, however RV structural parameters and indices of RV systolic and diastolic function were unchanged between in-exercise assessment points. Neither pulmonary artery pressures (26 ± 9 mmHg vs 17 ± 10 mmHg, P > 0.05) nor RV wall stress (7.1 ± 3.0 vs 6.2 ± 2.4, P > 0.05) were significantly elevated during exercise. Despite this, post-exercise measurements revealed RV dilation (increased RVD1 and 3), and reduced RV global strain (- 21.2 ± 3.5 vs - 23.8 ± 2.3, P = 0.0168) and diastolic tissue velocity (13.8 ± 2.5 vs 17.1 ± 3.4, P = 0.019) vs pre-exercise values. CONCLUSION A 6 h cycling exercise bout at 75% maximum heart rate did not alter RV structure, systolic or diastolic function assessments during exercise. Pulmonary artery pressures are not elevated beyond normal limits and therefore RV afterload is unchanged throughout exercise. Despite this, there is some evidence of RV dilation and altered function in post-exercise measurements.
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Affiliation(s)
- Rachel N Lord
- Centre for Health Activity and Wellbeing Research, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK.
| | - Zoe H Adams
- Centre for Health Activity and Wellbeing Research, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
- Countess of Chester Hospital, NHS Trust, Chester, UK
| | - Helen Jones
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool, UK
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Costa ADS, Ghouri I, Johnston A, McGlynn K, McNair A, Bowman P, Malik N, Hurren J, Bingelis T, Dunne M, Smith GL, Kemi OJ. Electrically stimulated in vitro heart cell mimic of acute exercise reveals novel immediate cellular responses to exercise: Reduced contractility and metabolism, but maintained calcium cycling and increased myofilament calcium sensitivity. Cell Biochem Funct 2023; 41:1147-1161. [PMID: 37665041 PMCID: PMC10947300 DOI: 10.1002/cbf.3847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
Cardiac cellular responses to acute exercise remain undescribed. We present a model for mimicking acute aerobic endurance exercise to freshly isolated cardiomyocytes by evoking exercise-like contractions over prolonged periods of time with trains of electrical twitch stimulations. We then investigated immediate contractile, Ca2+ , and metabolic responses to acute exercise in perfused freshly isolated left ventricular rat cardiomyocytes, after a matrix-design optimized protocol and induced a mimic for acute aerobic endurance exercise by trains of prolonged field twitch stimulations. Acute exercise decreased cardiomyocyte fractional shortening 50%-80% (p < .01). This was not explained by changes to intracellular Ca2+ handling (p > .05); rather, we observed a weak insignificant Ca2+ transient increase (p = .11), while myofilament Ca2+ sensitivity increased 20%-70% (p < .05). Acidic pH 6.8 decreased fractional shortening 20%-70% (p < .05) because of 20%-30% decreased Ca2+ transients (p < .05), but no difference occurred between control and acute exercise (p > .05). Addition of 1 or 10 mM La- increased fractional shortening in control (1 mM La- : no difference, p > .05; 10 mM La- : 20%-30%, p < .05) and acute exercise (1 mM La- : 40%-90%, p < .01; 10 mM La- : 50%-100%, p < .01) and rendered acute exercise indifferent from control (p > .05). Intrinsic autofluorescence showed a resting NADstate of 0.59 ± 0.04 and FADstate of 0.17 ± 0.03, while acute exercise decreased NADH/FAD ratio 8% (p < .01), indicating intracellular oxidation. In conclusion, we show a novel approach for studying immediate acute cardiomyocyte responses to aerobic endurance exercise. We find that acute exercise in cardiomyocytes decreases contraction, but Ca2+ handling and myofilament Ca2+ sensitivity compensate for this, while acidosis and reduced energy substrate and mitochondrial ATP generation explain this.
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Affiliation(s)
- Ana Da Silva Costa
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- Graduate School, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Iffath Ghouri
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Alexander Johnston
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Karen McGlynn
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Andrew McNair
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Peter Bowman
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Natasha Malik
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Johanne Hurren
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Tomas Bingelis
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Michael Dunne
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Godfrey L. Smith
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Ole J. Kemi
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
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Toro V, Jutras-Beaudoin N, Boucherat O, Bonnet S, Provencher S, Potus F. Right Ventricle and Epigenetics: A Systematic Review. Cells 2023; 12:2693. [PMID: 38067121 PMCID: PMC10705252 DOI: 10.3390/cells12232693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
There is an increasing recognition of the crucial role of the right ventricle (RV) in determining the functional status and prognosis in multiple conditions. In the past decade, the epigenetic regulation (DNA methylation, histone modification, and non-coding RNAs) of gene expression has been raised as a critical determinant of RV development, RV physiological function, and RV pathological dysfunction. We thus aimed to perform an up-to-date review of the literature, gathering knowledge on the epigenetic modifications associated with RV function/dysfunction. Therefore, we conducted a systematic review of studies assessing the contribution of epigenetic modifications to RV development and/or the progression of RV dysfunction regardless of the causal pathology. English literature published on PubMed, between the inception of the study and 1 January 2023, was evaluated. Two authors independently evaluated whether studies met eligibility criteria before study results were extracted. Amongst the 817 studies screened, 109 studies were included in this review, including 69 that used human samples (e.g., RV myocardium, blood). While 37 proposed an epigenetic-based therapeutic intervention to improve RV function, none involved a clinical trial and 70 are descriptive. Surprisingly, we observed a substantial discrepancy between studies investigating the expression (up or down) and/or the contribution of the same epigenetic modifications on RV function or development. This exhaustive review of the literature summarizes the relevant epigenetic studies focusing on RV in human or preclinical setting.
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Affiliation(s)
| | | | | | | | | | - François Potus
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), Québec, QC G1V 4G5, Canada; (V.T.); (N.J.-B.); (O.B.); (S.B.); (S.P.)
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Wang M, Lv C, Zhang Y, Liu K, Yan X, Liu L, Zheng Y, Guo X. Analysis and recognition of post-exercise cardiac state based on heart sound features and cardiac troponin I. Eur J Appl Physiol 2023; 123:2461-2471. [PMID: 37294516 DOI: 10.1007/s00421-023-05245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Excessive intensity exercises can bring irreversible damage to the heart. We explore whether heart sounds can evaluate cardiac function after high-intensity exercise and hope to prevent overtraining through the changes of heart sound in future training. METHODS The study population consisted of 25 male athletes and 24 female athletes. All subjects were healthy and had no history of cardiovascular disease or family history of cardiovascular disease. The subjects were required to do high-intensity exercise for 3 days, with their blood sample and heart sound (HS) signals being collected and analysed before and after exercise. We then developed a Kernel extreme learning machine (KELM) model that can distinguish the state of heart by using the pre- and post-exercise data. RESULTS There was no significant change in serum cardiac troponin I after 3 days of load cross-country running, which indicates that there was no myocardial injury after the race. The statistical analysis of time-domain characteristics and multi-fractal characteristic parameters of HS showed that the cardiac reserve capacity of the subjects was enhanced after the cross-country running, and the KELM is an effective classifier to recognize HS and the state of the heart after exercise. CONCLUSION Through the results, we can draw the conclusion that this intensity of exercise will not cause profound damage to the athlete's heart. The findings of this study are of great significance for evaluating the condition of the heart with the proposed index of heart sound and prevention of excessive training that causes damage to the heart.
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Affiliation(s)
- Menglu Wang
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Chengcong Lv
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Yao Zhang
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Kai Liu
- Communications Sergeant School, Army Engineering University of PLA, Chongqing, China.
| | - Xiaobo Yan
- College of Physical Education, Chongqing University, Chongqing, 401331, China
| | - Leichu Liu
- College of Physical Education, Chongqing University, Chongqing, 401331, China
| | - Yineng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xingming Guo
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China.
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40
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Rowe SJ, Paratz ED, Foulkes SJ, Janssens K, Spencer LW, Fahy L, D'Ambrosio P, Haykowsky MJ, La Gerche A. Understanding Exercise Capacity: From Elite Athlete to HFpEF. Can J Cardiol 2023; 39:S323-S334. [PMID: 37574129 DOI: 10.1016/j.cjca.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023] Open
Abstract
Exercise capacity is a spectrum that reflects an individual's functional capacity and the dynamic nature of cardiac remodelling along with respiratory and skeletal muscle systems. The relationship of increasing physical activity, increased cardiac mass and volumes, and improved cardiorespiratory fitness (CRF) is well established in the endurance athlete. However, less emphasis has been placed on the other end of the spectrum, which includes individuals with a more sedentary lifestyle and small hearts who are at increased risk of functional disability and poor clinical outcomes. Reduced CRF is an independent predictor of all-cause mortality and cardiovascular events determined by multiple inter-related exogenous and endogenous factors. In this review, we explore the relationship of physical activity, cardiac remodelling, and CRF across the exercise spectrum, emphasising the critical role of cardiac size in determining exercise capacity. In contrast to the large compliant left ventricle of the endurance athlete, an individual with a lifetime of physical inactivity is likely to have a small, stiff heart with reduced cardiac reserve. We propose that this might contribute to the development of heart failure with preserved ejection fraction in certain individuals, and is key to understanding the link between low CRF and increased risk of heart failure.
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Affiliation(s)
- Stephanie J Rowe
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen J Foulkes
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kristel Janssens
- Baker Heart and Diabetes Institute, Melbourne, Australia; Exercise and Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Luke W Spencer
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Louise Fahy
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Paolo D'Ambrosio
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Cardiology Department, Royal Melbourne Hospital, Parkville, Australia
| | - Mark J Haykowsky
- Baker Heart and Diabetes Institute, Melbourne, Australia; Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
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Ghekiere O, Herbots L, Peters B, Berg BV, Dresselaers T, Franssen W, Padovani B, Ducreux D, Ferrari E, Nchimi A, Demanez S, De Bosscher R, Willems R, Heidbuchel H, La Gerche A, Claessen G, Bogaert J, Eijnde BO. Exercise-induced myocardial T1 increase and right ventricular dysfunction in recreational cyclists: a CMR study. Eur J Appl Physiol 2023; 123:2107-2117. [PMID: 37480391 PMCID: PMC10492712 DOI: 10.1007/s00421-023-05259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Although cardiac troponin I (cTnI) increase following strenuous exercise has been observed, the development of exercise-induced myocardial edema remains unclear. Cardiac magnetic resonance (CMR) native T1/T2 mapping is sensitive to the pathological increase of myocardial water content. Therefore, we evaluated exercise-induced acute myocardial changes in recreational cyclists by incorporating biomarkers, echocardiography and CMR. METHODS Nineteen male recreational participants (age: 48 ± 5 years) cycled the 'L'étape du tour de France" (EDT) 2021' (175 km, 3600 altimeters). One week before the race, a maximal graded cycling test was conducted to determine individual heart rate (HR) training zones. One day before and 3-6 h post-exercise 3 T CMR and echocardiography were performed to assess myocardial native T1/T2 relaxation times and cardiac function, and blood samples were collected. All participants were asked to cycle 2 h around their anaerobic gas exchange threshold (HR zone 4). RESULTS Eighteen participants completed the EDT stage in 537 ± 58 min, including 154 ± 61 min of cycling time in HR zone 4. Post-race right ventricular (RV) dysfunction with reduced strain and increased volumes (p < 0.05) and borderline significant left ventricular global longitudinal strain reduction (p = 0.05) were observed. Post-exercise cTnI (0.75 ± 5.1 ng/l to 69.9 ± 41.6 ng/l; p < 0.001) and T1 relaxation times (1133 ± 48 ms to 1182 ± 46 ms, p < 0.001) increased significantly with no significant change in T2 (p = 0.474). cTnI release correlated with increase in T1 relaxation time (p = 0.002; r = 0.703), post-race RV dysfunction (p < 0.05; r = 0.562) and longer cycling in HR zone 4 (p < 0.05; r = 0.607). CONCLUSION Strenuous exercise causes early post-race cTnI increase, increased T1 relaxation time and RV dysfunction in recreational cyclists, which showed interdependent correlation. The long-term clinical significance of these changes needs further investigation. TRIAL REGISTRATION NUMBERS AND DATE NCT04940650 06/18/2021. NCT05138003 06/18/2021.
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Affiliation(s)
- Olivier Ghekiere
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Lieven Herbots
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Benjamin Peters
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | | | - Tom Dresselaers
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Franssen
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Nutrition and Movement Sciences; NUTRIM, School for Nutrition and Translation Research Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | | | - Emile Ferrari
- Department of Cardiology, University Hospital Nice, Nice, France
| | - Alain Nchimi
- Department of Radiology, Centre Hospitalier Universitaire Luxembourg, Luxembourg, Luxembourg
| | - Sophie Demanez
- Department of Cardiology, Centre Cardiologique Orban, Liège, Belgium
| | - Ruben De Bosscher
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Guido Claessen
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Bert O Eijnde
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Li YS, Ao YW, Zhu DY, Zhang L, Yang RJ, Zhao YL, Zha YF. Reduced myocardial strain of interventricular septum among male amateur marathon runners: a cardiac magnetic resonance study. J Sci Med Sport 2023; 26:506-513. [PMID: 37730468 DOI: 10.1016/j.jsams.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES To analyze the long-term effect of multiple marathons on cardiac structure and function in amateur marathon runners compared with healthy controls. DESIGN Cross-sectional study using male amateur marathon runners (n = 32) and age-matched cohort of male healthy controls (n = 12). METHODS A total of 32 male amateur marathon runners (age 44 ± 7 years) and 12 male healthy controls (age 42 ± 8 years) underwent cardiac magnetic resonance (CMR). The relevant parameters of cardiac structure and function were studied employing feature-tracking strain analysis. RESULTS Amateur marathon runners showed lower heart rates, body mass index and body surface area. The left ventricular (LV) mass index, LV end-diastolic volume index and right ventricular end-systolic volume index were significantly higher in amateur marathon runners compared with healthy controls. Furthermore, walls of interventricular septum (IVS) in amateur marathon runners were thicker than healthy controls. There was no significant difference between two groups in the global myocardial strain (MS) in LV. However, the segmental radial and circumferential strains of the LV were lower in amateur marathon runners compared to healthy controls, specifically in the 8th and 9th segments. Finally, we also found as the total running intensity increased, so did global longitudinal strain. CONCLUSIONS We reported higher wall thickness and lower regional radial and circumferential strain in the IVS region in amateur marathon runners, suggesting that prolonged and high-intensity exercise may cause cardiac remodeling. Further studies are needed to investigate whether this is an adaptive or maladaptive change in amateur marathon runners.
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Affiliation(s)
- Yu-Shuang Li
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Ya-Wen Ao
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Dong-Yong Zhu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Liang Zhang
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Ren-Jie Yang
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China
| | - Yi-Lin Zhao
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China.
| | - Yun-Fei Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Hubei Zhang Road, Wuchang District No. 99 Jiefang Road 238, Wuhan, Hubei 430060, China.
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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44
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Letnes JM, Wisløff U, Dalen H. Heart Failure With Preserved Ejection Fraction: Exercise Deficiency or Ventricular Maladaptation to Metabolic Demands? JACC Cardiovasc Imaging 2023; 16:1233-1235. [PMID: 37673477 DOI: 10.1016/j.jcmg.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 09/08/2023]
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45
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Pelliccia A, Ferrara R, Prosperi S, Spataro A, Maestrini V, Squeo MR. Long-Term Clinical Consequences of Right Ventricular Remodeling in Olympic Endurance Athletes. J Am Coll Cardiol 2023; 82:750-751. [PMID: 37587587 DOI: 10.1016/j.jacc.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 08/18/2023]
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46
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Piotrowska K, Zgutka K, Tkacz M, Tarnowski M. Physical Activity as a Modern Intervention in the Fight against Obesity-Related Inflammation in Type 2 Diabetes Mellitus and Gestational Diabetes. Antioxidants (Basel) 2023; 12:1488. [PMID: 37627482 PMCID: PMC10451679 DOI: 10.3390/antiox12081488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Diabetes is one of the greatest healthcare problems; it requires an appropriate approach to the patient, especially when it concerns pregnant women. Gestational diabetes mellitus (GDM) is a common metabolic condition in pregnancy that shares many features with type 2 diabetes mellitus (T2DM). T2DM and GDM induce oxidative stress, which activates cellular stress signalling. In addition, the risk of diabetes during pregnancy can lead to various complications for the mother and foetus. It has been shown that physical activity is an important tool to not only treat the negative effects of diabetes but also to prevent its progression or even reverse the changes already made by limiting the inflammatory process. Physical activity has a huge impact on the immune status of an individual. Various studies have shown that regular training sessions cause changes in circulating immune cell levels, cytokine activation, production and secretion and changes in microRNA, all of which have a positive effect on the well-being of the diabetic patient, mother and foetus.
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Affiliation(s)
- Katarzyna Piotrowska
- Department of Physiology, Pomeranian Medical University in Szczecin, al. Powstancow Wlkp. 72, 70-111 Szczecin, Poland
| | - Katarzyna Zgutka
- Department of Physiology in Health Sciences, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Zolnierska 54, 70-210 Szczecin, Poland
| | - Marta Tkacz
- Department of Physiology in Health Sciences, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Zolnierska 54, 70-210 Szczecin, Poland
| | - Maciej Tarnowski
- Department of Physiology in Health Sciences, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Zolnierska 54, 70-210 Szczecin, Poland
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47
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Perry AS, Dooley EE, Master H, Spartano NL, Brittain EL, Gabriel KP. Physical Activity Over the Lifecourse and Cardiovascular Disease. Circ Res 2023; 132:1725-1740. [PMID: 37289900 PMCID: PMC10254078 DOI: 10.1161/circresaha.123.322121] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite improvements in cardiovascular care in recent decades, cardiovascular disease (CVD) remains a leading cause of death worldwide. At its core, CVD is a largely preventable disease with diligent risk factor management and early detection. As highlighted in the American Heart Association's Life's Essential 8, physical activity plays a central role in CVD prevention at an individual and population level. Despite pervasive knowledge of the numerous cardiovascular and noncardiovascular health benefits of physical activity, physical activity has steadily decreased over time and unfavorable changes in physical activity occur throughout people's lives. Here, we use a lifecourse framework to examine the evidence reporting on the association of physical activity with CVD. From in utero to older adults, we review and discuss the evidence detailing how physical activity may prevent incident CVD and mitigate CVD-related morbidity and death across all life stages.
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Affiliation(s)
- Andrew S. Perry
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Erin E. Dooley
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hiral Master
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nicole L. Spartano
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Evan L. Brittain
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
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48
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Dokht Abdiyan R, Sadeghpour A, Alizadehasl A, Ahmadi A, Saed D, Ravasi AA, Akbarnejad A, Maleki M, Shariati A, Shahed A, Aziminia M. Effect of resistance exercise on cardiac perturbations and systolic performance: A cross-over randomized trial comparing volumes and techniques. J Sports Sci 2023; 41:1196-1206. [PMID: 37729561 DOI: 10.1080/02640414.2023.2260636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
This study investigated the magnitude and time-course of resistance exercise (RE) technique induced transient cardiac perturbations. Twenty-four participants were assigned to one of four arms: sets to failure or non-failure with 8-10 repetition maximum (RM), and sets to failure or non-failure with 15RM. Echocardiographic and blood pressure (BP) data were recorded at baseline and 30 min, 6 h and 24 h post-exercise. In all groups end-systolic circumferential wall stress (cESS), and ratio of transmitral inflow velocities (E/A) were significantly decreased while posterior wall thickness (PWT), global circumferential strain (GCS), GCS strain rate (GCSR), global longitudinal strain rate (GLSR), and stroke volume (SV) were significantly increased for up to 6 h of follow-up. In the 15RM groups, left ventricular (LV) mass and interventricular septal thickness (IVST) were significantly increased, and left atrial (LA) area was significantly decreased (p < 0.05) compared to the 8-10 RM groups. In the 15RM groups, RE decreased global longitudinal strain (GLS) and increased ejection fraction (EF) (p<0.01). After RE, transient cardiac perturbations, the reduction in LA compliance, and the improvement in LV myofibril geometry were volume dependent and influenced more by sets to failure technique. RE increased GCS and reduced the afterload, thus helping to preserve SV and EF.
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Affiliation(s)
- Rasoul Dokht Abdiyan
- Department of Exercise Physiology, School of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Anita Sadeghpour
- Echocardiography Research Center, Department of Cardiovascular Medicine, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Echocardiography Research Center, Department of Cardiovascular Medicine, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azizeh Ahmadi
- Department of Exercise Physiology, School of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Daryoush Saed
- Echocardiography Research Center, Department of Cardiovascular Medicine, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Ravasi
- Department of Exercise Physiology, School of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Ali Akbarnejad
- Department of Exercise Physiology, School of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Majid Maleki
- Echocardiography Research Center, Department of Cardiovascular Medicine, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Shariati
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Atabak Shahed
- Department of Exercise Physiology, School of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Mahdiye Aziminia
- Echocardiography Research Center, Department of Cardiovascular Medicine, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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49
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Segreti A, Celeski M, Monticelli LM, Perillo A, Crispino SP, Di Gioia G, Cammalleri V, Fossati C, Mega S, Papalia R, Pigozzi F, Ussia GP, Grigioni F. Mitral and Tricuspid Valve Disease in Athletes. J Clin Med 2023; 12:jcm12103562. [PMID: 37240669 DOI: 10.3390/jcm12103562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Observing mitral or tricuspid valve disease in an athlete raises many considerations for the clinician. Initially, the etiology must be clarified, with causes differing depending on whether the athlete is young or a master. Notably, vigorous training in competitive athletes leads to a constellation of structural and functional adaptations involving cardiac chambers and atrioventricular valve systems. In addition, a proper evaluation of the athlete with valve disease is necessary to evaluate the eligibility for competitive sports and identify those requiring more follow-up. Indeed, some valve pathologies are associated with an increased risk of severe arrhythmias and potentially sudden cardiac death. Traditional and advanced imaging modalities help clarify clinical doubts, allowing essential information about the athlete's physiology and differentiating between primary valve diseases from those secondary to training-related cardiac adaptations. Remarkably, another application of multimodality imaging is evaluating athletes with valve diseases during exercise to reproduce the sport setting and better characterize the etiology and valve defect mechanism. This review aims to analyze the possible causes of atrioventricular valve diseases in athletes, focusing primarily on imaging applications in diagnosis and risk stratification.
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Affiliation(s)
- Andrea Segreti
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Mihail Celeski
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Luigi Maria Monticelli
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Alfonso Perillo
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Simone Pasquale Crispino
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giuseppe Di Gioia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
- Institute of Sports Medicine, Sport and Health, National Italian Olympic Committee, Largo Piero Gabrielli, 00197 Roma, Italy
| | - Valeria Cammalleri
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Simona Mega
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
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50
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de la Guía-Galipienso F, Ugedo-Alzaga K, Grazioli G, Quesada-Ocete FJ, Feliu-Rey E, Perez MV, Quesada-Dorador A, Sanchis-Gomar F. Arrhythmogenic Cardiomyopathy and Athletes - A Dangerous Relationship. Curr Probl Cardiol 2023:101799. [PMID: 37172878 DOI: 10.1016/j.cpcardiol.2023.101799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3-20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.
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Affiliation(s)
- Fernando de la Guía-Galipienso
- From the Glorieta Policlinic, Denia, Alicante, Spain; REMA-Sports Cardiology Clinic, Denia, Alicante, Spain; Cardiology Service, Hospital HCB Benidorm, Alicante, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | | | | | - Francisco Javier Quesada-Ocete
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Eloísa Feliu-Rey
- Magnetic Resonance Unit, Inscanner, General University Hospital of Alicante, Alicante, Spain
| | - Marco V Perez
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Aurelio Quesada-Dorador
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA..
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