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

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.

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

ESC CardioMed ◽

10.1093/med/9780198784906.003.0705 ◽

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.

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'Athlete's Heart' in Prepubertal Children

PEDIATRICS ◽

10.1542/peds.79.5.800 ◽

1987 ◽

Vol 79 (5) ◽

pp. 800-804

Author(s):

Thomas W. Rowland ◽

Brian C. Delaney ◽

Steven F. Siconolfi

Keyword(s):

Physical Examination ◽

Left Ventricular Volume ◽

Volume Overload ◽

Ventricular Volume ◽

Left Ventricular ◽

Athlete’S Heart ◽

Endurance Athletes ◽

Routine Clinical Examination ◽

Ecg Alterations ◽

Athlete's Heart

Bradycardia, cardiomegaly, heart murmurs, and ECG changes are typically observed in adult endurance athletes, but frequency of such changes among children involved in sports training is unclear. Pediatricians need to be aware of whether these features of the " athlete's heart" occur in their patients, because such features may mimic those of cardiac disease. Fourteen prepubertal competitive male swimmers were evaluated by physical examination, ECG and echocardiogram, and findings were compared to those of a group of active but nontrained control boys. Lower resting heart rates and echocardiographic manifestations of chronic left ventricular volume overload were observed among the swimmers. These changes were not manifest on physical examination, however, and no significant ECG alterations were identified among the athletes. These findings indicate that, although features of the athlete's heart are present in children involved in endurance training, seldom will these findings simulate heart disease or be apparent on routine clinical examination.

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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

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From talented child to elite athlete: The development of cardiac morphology and function in a cohort of endurance athletes from age 12 to 18

European Journal of Preventive Cardiology ◽

10.1177/2047487320921317 ◽

2020 ◽

pp. 204748732092131

Author(s):

Anders W Bjerring ◽

Hege EW Landgraff ◽

Svein Leirstein ◽

Kristina H Haugaa ◽

Thor Edvardsen ◽

...

Keyword(s):

Wall Thickness ◽

Cardiopulmonary Exercise Testing ◽

Left Atrial Volume ◽

Posterior Wall ◽

Left Ventricular ◽

Athlete’S Heart ◽

Endurance Athletes ◽

Significant Difference ◽

Athlete's Heart

Background Adult athletes undergo cardiac adaptions in what is known as the “athlete’s heart”. Cardiac adaptations in young athletes have not been described in longitudinal studies but have previously been believed to be uniform in nature. Methods Seventy-six cross-country skiers were assessed at age 12. Forty-eight (63%) completed the first follow-up at age 15 and 36 (47%) the second follow-up at age 18. Comprehensive exercise data were collected. Echocardiography with three-dimensional measurements and cardiopulmonary exercise testing were performed at all time points. The cohort was divided into active and former endurance athletes, with an eight hours of weekly endurance exercise cut-off at age 18. Results The athletes underwent eccentric remodelling between ages 12 and 15, and concentric remodelling between ages 15 and 18. At age 18, the active endurance athletes had greater increases in inter-ventricular wall thickness (1.8 ± 1.4 Δmm vs 0.6 ± 1.0 Δmm, p < 0.05), left ventricular (LV) posterior wall thickness (1.6 ± 1.2 Δmm vs 0.8 ± 0.8 Δmm, p < 0.05), LV mass (63 ± 30 Δg vs 27 ± 21 Δg, p < 0.01), right ventricular (RV) end-diastolic area (3.4 ± 4.0 Δcm2 vs 0.6 ± 3.5Δ cm2, p < 0.05), RV end-systolic area (1.0 ± 2.3 Δcm2 vs –0.9 ± 2.0 Δcm2, p < 0.05) and left atrial volume (24 ± 21 ΔmL vs 6±10 ΔmL, p < 0.05) and had greater indexed maximal oxygen uptake (66.3 ± 7.4 mL/min/kg vs 57.1 ± 8.2 mL/min/kg, p < 0.01). There was no significant difference for LV volumes. Conclusion This study finds a shift in the development of the young athlete’s heart. Between ages 12 and 15, the active endurance athletes underwent eccentric remodelling. This dynamic switched to concentric remodelling between ages 15 and 18.

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T1 and ECV mapping texture analysis distinguishing hypertrophic cardiomyopathy from athletes heart better than median values

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.085 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

T Dresselaers ◽

P Rafouli-Stergiou ◽

R De Bosscher ◽

S Tilborghs ◽

C Dausin ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Texture Analysis ◽

Roc Analysis ◽

Left Ventricular ◽

Athlete’S Heart ◽

Support Vector ◽

Mapping Data ◽

Intensive Training ◽

Native T1 ◽

Athlete's Heart

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ph.D fellowship of the Research Foundation Flanders (FWO). The Master@Heart trial is funded by the FWO. Introduction Differentiating intensive training induced hypertrophy from hyperthropic cardiomyopathy (HCM) is important to identify those young athletes at risk of sudden cardiac death. Swoboda and colleagues demonstrated that T1 and ECV mapping can aid such a differentiation between athletic and pathological hypertrophy, particularly in subjects with indeterminate wall thickness (1). Recently texture analysis (TA) methods of CMR data have demonstrated improved diagnostic accuracy over conventional qualitative analysis in various heart diseases. Only few studies have applied TA to T1 and ECV mapping data (2-4). Here we aimed to demonstrate that a TA approach provides superior capacity to distinguish HCM from athlete’s heart over average native T1 and ECV values. Purpose It was our hypothesis that a texture analysis of T1 and ECV mapping images would identify features that could discriminate between a HCM and athlete’s heart with a higher classification accuracy (CA) than average T1 and ECV values. Methods This study included data from 97 subjects diagnosed with HCM (acc. to guidelines; 5) and 28 athletes that took part in the Master@Heart trial (an ongoing study assessing the beneficial effects of long-term endurance exercise for the prevention of coronary artery disease, 6). Long and short axis T1 mapping data was acquired on a 1.5T Philips Ingenia system using MOLLI (seconds scheme). After offline motion correction and T1 and ECV map calculation (7), the left ventricular myocardium was manually delineated (3D Slicer; 8). Texture analysis of the masked images resulted in 194 features (Pyradiomics, standard settings; 9). The dataset was then split (75/25%) for training and testing purposes keeping images from the same subject within the same set. A fast correlation based filter rank was applied to the training data to derive relevant features. A further reduction to only two features was based on the CA of a support vector machine (SVM) learning method (linear kernel; cost 0.9 regression loss epsilon 0.1; leave-one-out). Finally, ROC analysis on the test data was used to determine the diagnostic accuracy for the following predictors: (1) median T1 and ECV (2) two most relevant features (training) (3) combination of (1) and (2) (ROC AUC statistics (10)). Results The two most relevant features were the histogram feature ECV energy and the gray level size zone matrix (GLSZM) feature native T1 zone entropy, a measure of heterogeneity in the texture pattern. A model to distinguish HCM from athletes based on these features outperformed the model using only median T1 and ECV values with both higher sensitivity and specificity (table 1) and a significantly higher AUC in the ROC analysis (p < 0.05, figure 1). Combining these two features with median values did not improve the CA further. Conclusion Texture analysis of motion-corrected T1 and ECV mapping images out-performs classical analysis based on average values in distinguishing HCM from athlete"s heart.

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MECHANICS OF LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION IN PHYSIOLOGIC HYPERTROPHY OF THE ATHLETE'S HEART

Cardiology Clinics ◽

10.1016/s0733-8651(05)70345-3 ◽

1997 ◽

Vol 15 (3) ◽

pp. 355-372 ◽

Cited By ~ 27

Author(s):

Steven D. Colan

Keyword(s):

Diastolic Function ◽

Left Ventricular ◽

Athlete’S Heart ◽

Systolic And Diastolic Function ◽

Athlete's Heart

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Sports-Specific Adaptation of Left Ventricular Muscle Mass in Athlete's Heart

International Journal of Sports Medicine ◽

10.1055/s-2007-972916 ◽

1996 ◽

Vol 17 (S 3) ◽

pp. S145-S151 ◽

Cited By ~ 24

Author(s):

A. Urhausen ◽

T. Monz ◽

W. Kindermann

Keyword(s):

Muscle Mass ◽

Left Ventricular ◽

Athlete’S Heart ◽

Ventricular Muscle ◽

Specific Adaptation ◽

Left Ventricular Muscle Mass ◽

Athlete's Heart

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Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete’s heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097438 ◽

2017 ◽

Vol 52 (10) ◽

pp. 667-673 ◽

Cited By ~ 16

Author(s):

Alessandro Zorzi ◽

Chiara Calore ◽

Riccardo Vio ◽

Antonio Pelliccia ◽

Domenico Corrado

Keyword(s):

Differential Diagnosis ◽

Hypertrophic Cardiomyopathy ◽

European Society ◽

Left Ventricular ◽

Athlete’S Heart ◽

Ecg Changes ◽

Group 2 ◽

European Society Of Cardiology ◽

Athlete's Heart ◽

Group 1

BackgroundInterpretation of the athlete’s ECG is based on differentiation between benign ECG changes and potentially pathological abnormalities. The aim of the study was to compare the 2010 European Society of Cardiology (ESC) and the 2017 International criteria for differential diagnosis between hypertrophic cardiomyopathy (HCM) and athlete’s heart.MethodsThe study populations included 200 patients with HCM and 563 athletes grouped as follows: ‘group 1’, including normal ECG and isolated increase of QRS voltages, which are considered non-pathologic according to ESC and International criteria; ‘group 2’, including left atrial enlargement or left axis deviation in isolation and Q-waves with an amplitude ≥4 mm but <25% of the ensuing R-wave and a duration <0.04 s which are considered pathologic according to the ESC but not according to the International criteria; and ‘group 3’, including abnormalities which are considered pathologic according to ESC and International criteria.ResultsOverall, the 2010 ESC criteria showed a sensitivity of 95.5% and a specificity of 86.9%. Considering group 2 ECG changes as normal according to the International criteria led to a statistically significant (p<0.001) increase of specificity to 95.9%, associated with a non-significant (p=0.47) reduction of sensitivity to 93%. Among patients with HCM, there was a significant increase of maximal left ventricular wall thickness from group 1 to 3 (p=0.02).ConclusionsThe use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete’s heart.

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