Left ventricular hypertrophy in athletes and hypertensive patients

Abstract

Systemic hypertension and physical exercise are both associated with cardiac adaptations. The impact is most prominent on the left side of the heart, which hypertrophies leading to left ventricular hypertrophy. This article reviews structural and functional cardiac changes seen in hypertensive and athlete's hearts. | INTRODUCTIONChronically or intermittently elevated blood pressure (BP) increases systemic pressure and volume overload, with increased workload on the left ventricle and ultimately left ventricular (LV) hypertrophy (LVH). The normal left ventricle size (Table 1) undergoes several types of anatomical cardiac structural adaptations varying from concentric remodeling, eccentric remodeling, concentric hypertrophy, and eccentric hypertrophy to a combination of concentric and eccentric hypertrophy.1 Hypertensive LVH is a well-recognized risk factor for heart failure, myocardial infarction, arrhythmias, sudden cardiac death, and stroke. 2-4 Physical activity increases heart rate and BP. Regularly performed sports or physical activities of substantial volume and intensity lead to cardiac changes that meet the characteristic criteria for LVH, especially in highly trained individuals. 5,6 However, cardiac adaptations in response to increased physical activity, referred to as "athlete's heart," differ from the cardiac changes resulting from the pathologically elevated BP in hypertension. The objective of this review is to discuss and contrast the pathological and physiological cardiac adaptations associated with hypertension and chronic exercise. 7,8 | HYPERTENSIVE HEARTChronic, untreated systemic arterial hypertension leads to end organ damage. 3,4,8 The heart in chronic hypertension responds to the increased hemodynamic load with structural and functional changes.The structural changes include hypertrophy of existing myocytes and addition of sarcomeres together with an increase in connective tissue, ultimately leading to an overall increase in ventricular mass. 3,9,10 LV structural changes can include concentric or eccentric remodeling, concentric or eccentric hypertrophy, or a combination of concentric or eccentric hypertrophy, 1 with a varying combination of increase in LV wall thickness and LV diastolic and systolic dimensions (Table 2).In a recent publication from the Dallas Heart Study where 31% of the population was hypertensive, the prevalence of concentric LVH was much higher than that of eccentric hypertrophy. LVH was present in 730 (30%) of the 2458 patients, classified as indeterminate in 404, isolated thick (concentric) hypertrophy in 289, dilated (eccentric) hypertrophy in 30, and both thick and dilated hypertrophy in seven patients. On follow-up, outcome was worse in patients with dilated (eccentric) hypertrophy than in those with isolated thick (concentric) hypertrophy and worst in those who had a combination (both thick and dilated hypertrophy) of the two types of hypertrophy. 11In addition to structural changes, functional compensations with neurohormonal recruitment of sympathetic or renin-...

Metabolic profiling of elite athletes with different cardiovascular demand

“…However, it is plausible to assume that high CD athletes could manifest markers of higher risk of cardiovascular disease due to their intensive physical training that is associated with electrical, structural, and functional myocardial adaptations, 2,3 causing left ventricular hypertrophy and increased blood pressure. 22 Among the 112 metabolites associated with CD, 70 metabolites showed higher levels in athletes belonging to the low/moderate CD group compared to their counterparts in the high CD group, including metabolites indicative of energy generation, oxidative stress, and sterol biosynthesis. Elevation in a number of DAGs, fatty acid-carnitines and acylated carnitines suggest enhanced hydrolysis of diacylglycerols, followed by transfer of fatty acids inside the cells for oxidation and energy production.…”

“…In particular, the metabolic changes in high CD group may suggest increased cardiovascular risk, potentially due to exercise-induced left ventricular hypertrophy and increased blood pressure. 22 Out of the 112 metabolites associated with CD, 40 metabolites showed higher levels in athletes with high CD compared to their low/moderate CD counterpart. Among the elevated energy-related metabolites in the high CD group was adenine, the building block of ATP used in cellular metabolism as the main source of energy.…”

“…Despite predictability of some of the identified pathways that differentiate high and moderate CD groups, this study confirms known metabolic mediators of these pathways and identifies novel ones. In particular, the metabolic changes in high CD group may suggest increased cardiovascular risk, potentially due to exercise‐induced left ventricular hypertrophy and increased blood pressure …”

“…Whether these associations are truly predictive of increased risk of cardiovascular disease or just a reflection of differences in exercise and dietary requirement in high CD athletes compared to their low/moderate counterpart remains to be investigated. However, it is plausible to assume that high CD athletes could manifest markers of higher risk of cardiovascular disease due to their intensive physical training that is associated with electrical, structural, and functional myocardial adaptations, causing left ventricular hypertrophy and increased blood pressure …”

ECG conduction disturbances and ryanodine receptor expression levels in occupational lead exposure workers

“…The increase in QRS voltage is considered to be a specific ECG sign in left ventricular hypertrophy, which is a risk factor for cardiovascular morbidity and mortality and may be caused by hypertension 31. The production of left ventricular hypertrophy is to compensate for excessive pressure load by the heart in order to maintain normal left ventricular pumping function.…”