The term the "Athlete's Heart" was first used over 80 years ago, when by the use of percussion examination an increase in the heart size of cross country skiers was observed (9). Following these investigations the increase in the heart of endurance trained athletes could also be confirmed using radiographic methods (5, 25). An increase in the heart size is also a result of various pathologic processes, for instance a myocarditis, a pressure-or volume-overloading of the heart, a myocardial infarction etc., thus for many decades the enlarged heart of trained athletes was often regarded as being pathologic.Many investigations in particular the book by Reindell et a!. 1960 (28)using pathologico-anatomical, radiographic, electrocardiographic, haemodynaniic and spiroergometric investigations -showed that the heart, enlarged as a result of endurance training was not damaged but was an indication of a particularly efficient heart. Despite these investigations other researchers remained sceptical and repeatedly described the athlete's-heart-syndrome as pathologic: physiological variabilities were not recognized or often haemodynamic values were misinterpreted. Even in the American standard work by Friedberg "Diseases of the Heart" one could still read 7 years ago, that the athlete's heart was a syphilitically or rheumatically damaged heart (6). Recent investigations in particular those using echocardiography have produced a series of new results, which have increased our understanding about the trained heart and in particular about the different effects of various training types (1-4, 7, 8, 10-17, 27-35, 37-39).
The left ventricular volume (EDV), the left ventricular total volume (TDV), and the stroke volume (SV) of 40 male untrained subjects and 68 endurance athletes were determined using one-dimensional echocardiography, two-dimensional echocardiography, and a combined method. The accuracy of the volume and stroke volume measurements was checked by comparing them to ergometrically determined maximum oxygen pulse (max O2-P) and to radiographic heart volume (HV). There was clear improvement in the EDV, TDV, and SV measurements when using two-dimensional echocardiography and the combined method in comparison to one-dimensional echocardiography. The best correlation to the max-O2-P was reached by TDV2 (combined method, r = 0.8738). This method includes the myocardium of the left ventricle similar to heart volume measurements. The relationship is as close as between HV and max O2-P (r = 0.8665). The method suggested here is sufficiently accurate to be used in performance diagnosis to determine the size of the left ventricular volume and to classify pathological size changes or those due to training.
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