Abstract
Purpose
Endurance elite athletes are expected to present a cardiac remodelling, characterized by eccentric hypertrophy (EH), may be associated with higher sportive performances. However, not all can present a cardiac remodelling.
The study aimed to identify endurance athletes without cardiac remodelling characterizing their physiologic and clinical features.
Methods
We studied 309 endurance athletes (cycling, rowing, canoeing, triathlon, athletics, long-distance swimming, cross-country skiing, mid-long distance track, pentathlon, biathlon, long-distance skating and Nordic-combined) examined during period of training, by clinical evaluation, ECG, echocardiogram and exercise-stress test. Sport career achievements (Olympic\World championship medals or national\world records) were recorded.
Results
EH was found in most of athletes, (n = 126, 67% of males; n = 85, 68.5% of females). A significant proportion,, exhibited normal geometry (NG) ( n = 59, 31.3% in males; n = 39, 31.4% in females). At stress test, significant differences between EH and NG athletes were found in peak power (317.1 ± 71.2W in NG vs. 342.2 ± 60.6W in EH, p = 0.014 in males and 225.1 ± 38.7W in NG vs. 247.1 ± 37W in EH, p = 0.003 in females), rest heart rate (66.1 ± 13 in NG vs. 58.6 ± 11.6 in EH, p = 0.001 in males and 68 ± 13.2 in NG vs. 59.2 ± 11.2 in EH, p = 0.001 in females) with similar ventricular extrasystoles (p = 0.363 in males and p = 0.492 in females). However, no significant differences in athletic achievements were registered.
Conclusion
Our study demonstrates a relatively high prevalence of NG in endurance athletes, in addition to the expected EH. Athletes with NG perform worse in exercise-stress test and exhibit some less advantageous functional heart characteristics. However, the type of heart geometry is not associated with negative clinical findings.
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Data availability
De-identified participant data are available upon reasonable request from the corresponding author.
Abbreviations
- BMI:
-
Body mass index
- BSA:
-
Body surface area
- CH:
-
Concentric hypertrophy
- CMR:
-
Cardiac magnetic resonance
- CR:
-
Concentric remodelling
- EF:
-
Ejection fraction
- EH:
-
Eccentric hypertrophy
- LAD:
-
Left atrial diameter
- LAV:
-
Left atrial volume
- LV:
-
Left ventricular
- LVEDD:
-
Left ventricle end-diastolic diameter
- LVEDV:
-
Left ventricle end-diastolic volume
- LVESV:
-
Left ventricle end-systolic volume
- LVM:
-
Left ventricular mass
- LVMi:
-
Left ventricular mass indexed
- NG:
-
Normal geometry
- PW:
-
Pulsed wave Doppler
- RAA:
-
Right atrial area
- RVOT:
-
Right ventricle outflow tract
- RWT:
-
Relative wall thickness
- TDI:
-
Tissue Doppler imaging
- TTE:
-
Transthoracic echocardiography
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All authors have approved the final article and approved the submission. GDG, SPC, MRS: conception and design of the study; SM, VM, DO, AP, AS, EL, AN: acquisition of data, or analysis and interpretation of data; EL, MRS, AS, AN: drafting the article or revising it critically for important intellectual content; GDG, AP: final approval of the version to be submitted.
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The study design of the present investigation was evaluated and approved by the Review Board of the Institute of Medicine and Sports Science. All athletes included in this study were fully informed of the types and nature of the evaluation and signed the consent form, according to Italian Law and Institute policy. All clinical data assembled from the study population are maintained in an institutional database.
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Communicated by Ellen Adele Dawson.
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Di Gioia, G., Crispino, S.P., Maestrini, V. et al. Lack of cardiac remodelling in elite endurance athletes: an unexpected and not so rare finding. Eur J Appl Physiol (2024). https://doi.org/10.1007/s00421-024-05489-0
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DOI: https://doi.org/10.1007/s00421-024-05489-0