Exercise-induced arterial hypertension - an independent factor for hypertrophy and a ticking clock for cardiac fatigue or atrial fibrillation in athletes?

Abstract

Background : Exercise-induced arterial hypertension (EIAH) leads to myocardial hypertrophy and is associated with a poor prognosis. EIAH might be related to the “cardiac fatigue” caused by endurance training. The goal of this study was to examine whether there is any relationship between EIAH and left ventricular hypertrophy in Ironman-triathletes. Methods: We used echocardiography and spiroergometry to determine the left ventricular mass (LVM), the aerobic/anaerobic thresholds and the steady-state blood pressure of 51 healthy male triathletes. The main inclusion criterion was the participation in at least one middle or long distance triathlon. Results: When comparing triathletes with LVM <220g and athletes with LVM >220g there was a significant difference between blood pressure values (BP) at the anaerobic threshold (185.2± 21.5 mmHg vs. 198.8 ±22.3 mmHg, p=0.037). The spiroergometric results were: maximum oxygen uptake (relative VO 2max) 57.3 ±7.5ml/min/kg vs. 59.8±9.5ml/min/kg (p=ns). Cut-point analysis for the relationship of BP >170 mmHg at the aerobic threshold and the probability of LVM >220g showed a sensitivity of 95.8%, a specificity of 33.3%, with a positive predictive value of 56.8 %, a good negative predictive value of 90%. The probability of LVM >220g increased with higher BP during exercise (OR: 1.027, 95% CI 1.002-1.052, p= 0.034) or with higher training volume (OR: 1.23, 95% CI 1.04 -1.47, p = 0.019). Echocardiography showed predominantly concentric remodelling, followed by concentric hypertrophy. Conclusion: Significant left ventricular hypertrophy with LVM >220g is associated with higher arterial blood pressure at the aerobic or anaerobic threshold. The endurance athletes with EIAH may require a therapeutic intervention to at least prevent extensive stiffening of the heart muscle and exercise-induced cardiac fatigue.

The forensic pathological analysis of sport-related sudden cardiac death in Southern China

“…This is the first study to report the aetiology distribution and basic epidemiology data of sportrelated SCD cases (including both young athletes and the general population) in Southern China from the perspective of forensic identification. The incidence of sudden death (SD) in the competitive athletes ranged from 0.4 to 2.3 per 100 000 per year [3,5,6,[13][14][15]. However, the incidence of leisure sport-related SD in the general population remains sparse.…”

“…As for physical activity, it is well accepted that regular physical activities play a positive role in health, especially in the cardiovascular system. On the contrary, physical exertion, including intensive exercise and heavy physical activity, is associated with cardiac fatigue [3] and increases the risk of SCD [4]. Nowadays, public and research attention mainly focuses on sport-related SCD in young competitive athletes, and several studies regarding this have been performed in different countries [5][6][7].…”

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

“…Problematisch ist, dass die Herzmuskelhypertrophie (und das "Sportlerherz") kaum "nur" durch körperliche Aktivität entsteht. Bei der sportbedingten Herzhypertrophie spielen weitere Faktoren wie Genetik [26], Art des ausgeübten Sports und belastungsinduzierter Hochdruck [40] eine wichtige Rolle (q Abb. 2).…”

Left Ventricular Function and Physiological Performance in Female Ironman Athletes and Female Police Officers

“…Fagard (1996) and Pluim, Zwinderman, van der Laarse, & van der Wall (2000) reported sport-specific adaptations of the left ventricle in athletes of different sports. Exercise-induced hypertension increases the development of muscle mass in athletes (Leischik, Spelsberg, Niggemann, Dworrak, & Tiroch, 2014), in a continuum between static and dynamic work during exercise. Both meta-analyses showed the highest left ventricular mass for athletes with a static and dynamic mix (rowers and cyclists).…”