Athlete’s heart and prevention of sudden cardiac death in athletes

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

Download Full-text

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽

10.1093/med/9780198784906.003.0705_update_001 ◽

2018 ◽

pp. 2913-2916

Author(s):

Michael Papadakis ◽

Sanjay Sharma

Keyword(s):

Female Athletes ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Left Ventricular ◽

Athlete’S Heart ◽

Endurance Athletes ◽

Physiological Adaptation ◽

Imaging Studies ◽

Eccentric Hypertrophy ◽

Athlete's Heart ◽

Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

Download Full-text

Morte súbita cardíaca em atletas e testes genéticos para as canalopatias

Revista de Medicina ◽

10.11606/issn.1679-9836.v96i3p159-164 ◽

2017 ◽

Vol 96 (3) ◽

pp. 159

Author(s):

Claudia Yamada Utagawa ◽

Pedro De Souza Rondinelli ◽

Sarah Sterphane Fernandes

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Athlete’S Heart ◽

De Se ◽

Athlete’S Heart Syndrome ◽

Athlete's Heart

Ocasionalmente ocorrem mortes súbitas em atletas e sabe-se que um percentual desses eventos é por morte súbita cardíaca (MSC), algumas delas por canalopatias, doenças que muitas vezes possuem manifestação silenciosa. A presente revisão sistemática visa analisar a relevância da adoção de testes moleculares para o diagnóstico precoce dessas canalopatias afim de se diminuir a incidência de MSC em atletas de elite. Para analisar a questão proposta, foi realizado levantamento bibliográfico na base de dados Pubmed, utilizando as palavras-chaves channelopathies, sudden cardiac death e athlete’s heart syndrome, sendo resgatados 35 artigos. Desses, dezoito artigos eram revisões sistemáticas, um estudo prospectivo e um estudo de corte e, no final, vinte artigos foram selecionados. De acordo com os resultados encontrados, percebeu-se que pelo fato das canalopatias serem doenças genéticas que podem ser hereditárias, a história familiar deve ser sempre valorizada durante a anamnese. Além disso, cerca de 3,6% das mortes súbitas são causadas por canalopatias em atletas. Os testes genéticos para as principais canalopatias entretanto, não se mostraram eficazes na prevenção de morte súbita cardíaca pelo alto custo, baixa disponibilidade, baixo valor preditivo negativo (<40%) e poucos estudos prospectivos bem delineados com uma população estatisticamente significativa.

Download Full-text

Exercise, the Athlete's Heart, and Sudden Cardiac Death

The Physician and Sportsmedicine ◽

10.3810/psm.2014.05.2062 ◽

2014 ◽

Vol 42 (2) ◽

pp. 100-113 ◽

Cited By ~ 6

Author(s):

Andrew D'Silva ◽

Sanjay Sharma

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Athlete’S Heart ◽

Athlete's Heart

Download Full-text

Cardiac Biomarkers and Autoantibodies in Endurance Athletes: Potential Similarities with Arrhythmogenic Cardiomyopathy Pathogenic Mechanisms

International Journal of Molecular Sciences ◽

10.3390/ijms22126500 ◽

2021 ◽

Vol 22 (12) ◽

pp. 6500

Author(s):

Ilaria Stadiotti ◽

Melania Lippi ◽

Angela Serena Maione ◽

Paolo Compagnucci ◽

Daniele Andreini ◽

...

Keyword(s):

Physical Activity ◽

Early Recognition ◽

Athlete’S Heart ◽

Endurance Athletes ◽

Cardiac Biomarkers ◽

Autoimmune Response ◽

Myocardial Inflammation ◽

Arrhythmogenic Cardiomyopathy ◽

Exercise Induced ◽

Athlete's Heart

The “Extreme Exercise Hypothesis” states that when individuals perform training beyond the ideal exercise dose, a decline in the beneficial effects of physical activity occurs. This is due to significant changes in myocardial structure and function, such as hemodynamic alterations, cardiac chamber enlargement and hypertrophy, myocardial inflammation, oxidative stress, fibrosis, and conduction changes. In addition, an increased amount of circulating biomarkers of exercise-induced damage has been reported. Although these changes are often reversible, long-lasting cardiac damage may develop after years of intense physical exercise. Since several features of the athlete’s heart overlap with arrhythmogenic cardiomyopathy (ACM), the syndrome of “exercise-induced ACM” has been postulated. Thus, the distinction between ACM and the athlete’s heart may be challenging. Recently, an autoimmune mechanism has been discovered in ACM patients linked to their characteristic junctional impairment. Since cardiac junctions are similarly impaired by intense physical activity due to the strong myocardial stretching, we propose in the present work the novel hypothesis of an autoimmune response in endurance athletes. This investigation may deepen the knowledge about the pathological remodeling and relative activated mechanisms induced by intense endurance exercise, potentially improving the early recognition of whom is actually at risk.

Download Full-text

Sudden Cardiac Death and the `Athlete's Heart'

Archives of Internal Medicine ◽

10.1001/archinte.1995.00430140021002 ◽

1995 ◽

Vol 155 (14) ◽

pp. 1473 ◽

Cited By ~ 30

Author(s):

Joseph N Wight

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Athlete’S Heart ◽

Athlete's Heart

Download Full-text

Sudden cardiac death and the 'athlete's heart'

Archives of Internal Medicine ◽

10.1001/archinte.155.14.1473 ◽

1995 ◽

Vol 155 (14) ◽

pp. 1473-1480 ◽

Cited By ~ 5

Author(s):

J. N. Wight

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Athlete’S Heart ◽

Athlete's Heart

Download Full-text

Abstract 12760: Left Ventricular (LV) Remodeling in Aortic Regurgitation Differs From Athlete’s Heart With Similar LV Volumes and is Closely Related to Different Fiber Stress Distribution

Circulation ◽

10.1161/circ.130.suppl_2.12760 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kaspar Broch ◽

Stefano deMarchi ◽

Richard Massey ◽

Svend Aakhus ◽

Lars Gullestad ◽

...

Keyword(s):

Stress Distribution ◽

Aortic Regurgitation ◽

Strain Curve ◽

Left Ventricular ◽

Athlete’S Heart ◽

Endurance Athletes ◽

Fiber Stress ◽

Lv Remodeling ◽

Lv Volumes ◽

Athlete's Heart

Introduction: Elite endurance athletes often develop left ventricular dilatation comparable to that observed in aortic regurgitation (AR). Hypothesis: We hypothesized that the LV remodeling observed in athlete’s heart differs from that seen in AR, and that the difference may be attributed to different fiber stress distribution. Methods: Thirty asymptomatic patients with moderate to severe AR, 15 age matched elite endurance athletes (Athl) and 17 age matched healthy controls (C) where analyzed with 3D speckle tracking echocardiography. We calculated the ratio between peak systolic circumferential (CS) - and peak systolic longitudinal strain (LS) and end-systolic (ES) circumferential (ESSc) and meridional (ESSm) fiber stress. Results: LV ejection fraction in C, Athl and AR patients was (61 ± 2, 61 ± 3 and 62 ± 3%, respectively, p=NS). LV end-diastolic volume was 78 ± 11, 112 ± 13 and 117 ± 20 ml/m 2 in C, Athl and AR, respectively, (C vs AR and Athl, p<0.01, AR vs Athl, p=NS). A non-uniform contraction pattern with a rightward shift of the LS strain curve was observed in AR (Figure 1). The CS/LS ratio was 0.91 ± 0.11, 0.91 ± 0.16 and 1.12 ± 0.24 in C, Athl and AR, respectively, (AR vs C and Athl, p<0.01, C vs Athl, p=NS). Consistently, the ESSc/ESSm ratio was similar in C and Athl (1.75 ± 0.08 and 1.74 ± 0.07, respectively, p=NS) and lower in AR patients (1.67 ± 0.07, AR vs C and Athl, p<0.01), indicating a relative increase in meridional fiber stress in the AR group (Figure 2). Conclusions: We have demonstrated that LV remodeling in AR patients differs from athlete’s heart with similar LV volumes, and may be attributed to a shift in the circumferential-meridional fiber stress ratio in AR patients.

Download Full-text