“Supranormal” Cardiac Function in Athletes Related to Better Arterial and Endothelial Function

Abstract

"Supranormal" cardiac function in athletes is due to better endothelial and arterial function, related to lower oxidative stress, with optimized ventriculo-arterial coupling; athlete's heart is purely a physiological phenomenon, associated with "supranormal" cardiac function, and there are no markers of myocardial fibrosis.

Predominance of normal left ventricular geometry in the male ‘athlete's heart’

“…This supports some previous data18 but contradicts the study by Florescu and colleagues,22 who observed significantly higher longitudinal velocities in ET in comparison to CT. One possible reason for the contradictory outcomes between studies in relation to TDI data could be the inconsistent approach to scaling tissue velocities. Batterham et al 23 documented that S′ and E′ were proportional to LV length, providing empirical support for the scaling procedures adapted by Pela et al 24 and the current study.…”

Flow-Mediated Dilation in Athletes

“…As for the duration of blood flow occlusion, 23 studies used a 5-min period, whereas six studies reported periods between 4 and 5 min (1,23,27,44,50,56). Peak brachial diameter after cuff deflation (i.e., during hyperemia) was determined via continuous ultrasound scan in 20 studies (1,3,(12)(13)(14)20,27,36,40,49,50,59,60) and single time point(s) ultrasound scan in seven studies (23,29,32,(44)(45)(46)56), and one study did not report such information (37). Time to peak brachial diameter after cuff deflation was reported in one study (3).…”

“…It has been proposed that long-term training may result in the enlargement of conduit arteries, which in turn could reduce (normalize) the effect of shear stress on the endothelium and thus diminish the stimulus for FMD enhancement in athletes (20,30). Alternative explanations for the discrepant FMD results in athletes may lie in the inherent limitations of cross-sectional comparisons and the small sample sizes of previous individual studies (1,3,(12)(13)(14)20,23,27,29,32,36,37,40,(44)(45)(46)49,50,56,59,60). In addition, longitudinal studies have been predominantly based on relatively short-to medium-term training interventions, hence plausibly assessing incomplete vascular adaptations (53).…”

Can Intensive Exercise Harm the Heart?

“…The functional outcome of this improved myocardial and vascular compliance was that their ventricular-arterial coupling was substantially better (>2× the increase in stroke volume for any given increase in left ventricular filling pressure) than their healthy but unfit counterparts 30 ; enhanced ventricular-arterial coupling is also a hallmark of highly trained young endurance athletes. 31 This discussion is particularly important because some investigators have suggested that intense marathon training leads to cardiac fibrosis. 32 However, in this high-profile study of 102 middle-aged marathon runners, there was no statistically significant difference between the prevalence of positive delayed enhancement by cMRI in the athletes compared with a group of controls from the Heinz nixdorf recall study.…”