Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations

Baggish, Aaron L.; Castillo‐García, Adrián; Santos‐Lozano, Alejandro; Boraita, Araceli; Lucı́a, Alejandro

doi:10.1002/cphy.c210045

Cited by 6 publications

(4 citation statements)

References 215 publications

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“…T he benefits of regular physical activity (PA; e.g., walking or brisk walking) on cardiovascular risk and mortality are irrefutable (1), with growing evidence for an inverse dose-response association (2,3). However, concerns exist as to whether long-term exposure to strenuous endurance exercise (SEE), especially at the competition level (e.g., marathon running, cross-country skiing, cycling) could induce some deleterious cardiac effects (4)(5)(6). At the morphological level, these would include mainly an increased risk of myocardial fibrosis and coronary calcification (7).…”

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confidence: 99%

Myocardial Fibrosis and Coronary Calcifications Caused by Endurance Exercise? Insights from Former Professional Cyclists

Maceira¹,

Santos‐Lozano

García-González³

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose: This study aimed to compare the prevalence of myocardial fibrosis and coronary calcification in individuals who have performed very high levels of strenuous endurance exercise (SEE; former male professional cyclists) and sex/age-matched controls. Methods: We used a retrospective cohort study design, where cases were former finishers of ≥1 Grand Tour (Tour de France, Giro d' Italia or Vuelta a España) and controls were untrained individuals free of cardiovascular risk. All participants underwent cardiac magnetic resonance and cardiac computer tomography in the same center during years 2020-2021 to detect myocardial fibrosis (late gadolinium enhancement) and to quantify coronary calcium, respectively. Results: Twenty-three cases (age, 46 ± 6 yr) and 59 controls (47 ± 7 yr) were studied. Fibrotic patches were evidenced only in the left ventricle, with a higher prevalence in cases (23% vs 2% in controls, P = 0.006). However, fibrotic tissue was nonischemic and of low extension (0.6% ± 0.4% of left ventricle mass), and no significant differences were found between cases and controls for native T1 or T2 values. No between-group differences were found for coronary calcium indicators, including Agatston or density scores. Subanalyses revealed no differences attending to whether cases were still performing regular SEE (n = 8) or not (n = 15) after professional retirement. Conclusions: Although former professional cyclists seemed to show a greater prevalence of myocardial fibrosis, the extension of fibrotic tissue was minimal and no alterations were found in coronary calcification indicators. While keeping in mind the low sample size of the cases' group, our results do not support evidence for major cardiac maladaptations with long-term exposure to SEE, at least in middle-age adults.

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confidence: 99%

Myocardial Fibrosis and Coronary Calcifications Caused by Endurance Exercise? Insights from Former Professional Cyclists

Maceira¹,

Santos‐Lozano

García-González³

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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“…In this regard, some evidence suggests that aortic calcifications are positively associated with cardiovascular risk, but this association disappears when adjusting for coronary calcifications (14). In addition, it remains unclear whether calcifications translate into a higher risk in athletes (1,29). Notwithstanding, given the association reported by previous studies between thoracic aorta calcifications and cardiovascular events in the general population (33) (with this association being potentially independent of coronary calcifications, at least in women) (13), future research should confirm the clinical relevance of our findings.…”

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confidence: 99%

“…espite traditionally receiving less attention than changes in cardiac dimensions (i.e., the so-called athlete's heart) (1), aortic remodeling can also occur in athletes, as they usually show larger aortic root diameters than the general population (2). Controversy exists, however, on the prevalence of clinically relevant aortic dilatation (conventionally defined as diameters ≥40 mm for male athletes) (3), with this condition being infrequent (~1%) in young athletes (mean age, 19-25 yr) (4)(5)(6) but not in their master peers (i.e., 21%-30% in those age 57-71 yr) (7,8).…”

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Aortic Diameters and Calcifications in Former World-Class Cyclists

Maceira¹,

Santos‐Lozano

García-González³

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose: Concerns on whether athletes--particularly older ones--are at an increased risk of pathological aortic dilation exist, and the prevalence of aortic calcifications in these individuals is unknown. We aimed to compare the dimensions, distensibility, and prevalence of calcifications in the thoracic aorta between former male professional cyclists (cases) and sex/age-matched controls. Methods: We used a retrospective cohort design, where cases were former finishers of at least one Grand Tour (Tour de France, Giro d' Italia or Vuelta a España) and controls were untrained individuals with no previous sports history and free of cardiovascular risk. All participants underwent magnetic resonance and computer tomography assessments for the measurement of aortic dimensions and calcifications, respectively. Results: Cases showed larger (P < 0.05) dimensions than controls for aortic annulus, sinus, and arch, as well as for ascending and descending aorta. However, none of the participants presented with pathological aortic dilation (all diameters <40 mm). A slightly higher prevalence of calcifications in the ascending aorta was observed in cases (13% vs 0% in controls, P = 0.020). Subanalyses confirmed that cases who were still competing (masters category, n = 8) had larger aortic diameters (P < 0.05) and a greater presence of calcifications in the ascending/descending aorta (38% vs 0% for both segments, P = 0.032) than those who had become inactive (n = 15). No between-group differences were found for aortic distensibility. Conclusions: Former professional cyclists, particularly those who are still competing after retirement, show enlarged aortic diameters (albeit without exceeding upper limits of normality). Former professional cyclists also showed a slightly higher prevalence of calcifications in the ascending aorta than controls, although aortic distensibility was not compromised. The clinical relevance of these findings should be the subject of future studies.

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Dilemmas in recommending exercise for prevention of heart failure with preserved ejection fraction

Bocchi,

Biselli,

Guimarães

2024

European J of Heart Fail

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Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations

Cited by 6 publications

References 215 publications

Myocardial Fibrosis and Coronary Calcifications Caused by Endurance Exercise? Insights from Former Professional Cyclists

Myocardial Fibrosis and Coronary Calcifications Caused by Endurance Exercise? Insights from Former Professional Cyclists

Aortic Diameters and Calcifications in Former World-Class Cyclists

Dilemmas in recommending exercise for prevention of heart failure with preserved ejection fraction

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