Endurance Sport and “Cardiac Injury”: A Prospective Study of Recreational Ironman Athletes

Abstract

Background: Participation in triathlon competitions has increased in recent years. Many studies have described left or right ventricular injury in endurance athletes. The goal of this study was to examine the right and left ventricular cardiac structures and function and dynamic cardio-pulmonary performance in a large cohort of middle- and long-distance triathletes. Methods: 87 triathletes (54 male and 33 female) were examined using spiroergometry and echocardiography. The inclusion criterion was participation in at least one middle- or long distance triathlon. Results: Male triathletes showed a maximum oxygen absorption of 58.1 ± 8.6 mL/min/kg (female triathletes 52.8 ± 5.7 mL/min/kg), maximum ergometer performance of 347.8 ± 49.9 W (female triathletes 264.5 ± 26.1 W). Left ventricular ejection fraction (EF) was normal (male triathletes EF: 61.9% ± 3%, female triathletes EF: 63.0% ± 2.7%) and systolic right ventricular area change fraction (RV AFC%) showed normal values (males RV AFC%: 33.5% ± 2.2%, females 32.2% ± 2.8%). Doppler indices of diastolic function were normal in both groups. With respect to the echocardiographic readings the left ventricular mass for males and females were 217.7 ± 41.6 g and 145.9 ± 31.3 g, respectively. The relative wall thickness for males was 0.50 ± 0.07, whereas it was 0.47 ± 0.09 for females. The probability of left ventricular mass >220 g increased with higher blood pressure during exercise (OR: 1.027, CI 1.002–1.052, p = 0.034) or with higher training volume (OR: 1.23, CI 1.04–1.47, p = 0.019). Conclusions: Right or left ventricular dysfunction could not be found, although the maximal participation in triathlon competitions was 29 years. A left ventricular mass >220 g is more likely to occur with higher arterial pressure during exercise and with a higher training volume.

Myocardial Adaptation to High-Intensity (Interval) Training in Previously Untrained Men With a Longitudinal Cardiovascular Magnetic Resonance Imaging Study (Running Study and Heart Trial)

“…The discrepancy to a recently published study by Breuckmann et al 11 showing myocardial LGE in 12% of healthy male marathon runners (n=102) aged 50 to 72 years and 4% in the age-matched control group could be explained by the selection of participants in our trial (age range, 30-50 years; no history of cardiac disease; no competitive sports), which is in accordance to Karlstedt et al 32 LV and RV ejection fraction in our study did not alter with training. This finding corresponds to results of previous echocardiographic 33 and CMR imaging studies 34 that showed that even dramatic changes in training loads do not influence this index of integrated ventricular systolic function at rest. Therefore, we conclude that the increase in stroke volume in the HI(I)T group is attributable to the larger EDV of hypertrophied ventricles, despite higher endsystolic volume.…”

Differences in echocardiography, blood pressure, stroke volume, maximal power and profile of genes related to cardiac hypertrophy in elite road cyclists

“…It is well established in sport physiology that endurance training may improve exercise capacity and cardiac function at rest and during exercise. 5,17 Echocardiographic examinations of all cyclists showed that LVH subjects had an increase in LVMI (p < 0.001), as well as, higher LVPWT (p < 0.05) and IVSDD (p < 0.05). Similar differences were observed in the mass of the left ventricular in other endurance athletes.…”

“…2,3 That is why the world's sporting and cardiology organizations recommend that medical examinations be performed on competitive endurance athletes for the early detection of possible pathologies. 4,5 Strenuous exercise, such as road cycling, may result in compensatory myocardial hypertrophy, commonly known as athlete's heart. 6 The main morphologic characteristics are left ventricular hypertrophy (LVH), an increase in the coronary reserve and improvement of left ventricular myocardial contractility.…”

Kardiovaskuläre Vorsorge im Breitensport, ambitionierten Freizeitsport und Wettkampfsport über das 35. Lebensjahr hinaus

“…Eine Echokardiographie erfolgt hauptsächlich, um die Größe der Kammern/Vorhöfe zu vergleichen und eventuelle Veränderungen im Bereich der Herzklappen und der Aorta zu erfassen [65]. Eine Aortenerweiterung [65] mit konsekutiver Aortenklappeninsuffizienz ist bei Ausdauersportlern nicht selten (2%) [39]. Bei ambitionierten und Wettkampfsportlern erfolgt außerhalb der WettkampfSaison oft eine Spiroergometrie, um die Trainingsplanung zu über-prüfen; bei Leistungssportlern auch in der Vor-Wettkampfphase.…”

“…Die Diagnostik mittels Spiroergometrie ist extrem wichtig bei der Trainingsplanung und der Leistungsbeurteilung bei aktiven Sportlern [39] sowie bei der Aktivitätsplanung der betroffenen Patienten [30]. Nur die Spiroergometrie liefert in der Gesamtheit der Daten eine optimale Beurteilung des Sportlers/des Patienten bezüglich der Fettverbrennung, der Trainingsbereiche und der Leistungseinschätzung.…”