Three-dimensional regional bi-ventricular shape remodeling is associated with exercise capacity in endurance athletes

Abstract

Aims: Endurance athletes develop cardiac remodeling to cope with increased cardiac output during exercise. This remodeling is both anatomical and functional and shows large interindividual variability. In this study, we quantify local geometric ventricular remodeling related to long-standing endurance training and assess its relationship with cardiovascular performance during exercise. Methods:We extracted 3D models of the biventricular shape from end-diastolic cine Magnetic Resonance images acquired from a cohort of 89 triathlon athletes and 77 healthy sedentary subjects. Additionally, the athletes underwent Cardio-Pulmonary Exercise Testing, together with an echocardiographic study at baseline and few minutes after maximal exercise. We used Statistical Shape Analysis to identify regional bi-ventricular shape differences between athletes and non-athletes. Results:The ventricular shape was significantly different between athletes and controls (p<1e-6). The observed regional remodeling in the right heart was mainly a shift of the right ventricle (RV) volume distribution towards the right ventricular infundibulum, increasing the overall right ventricular volume. In the left heart, there was an increment of left ventricular mass and a dilation of the left ventricle. Within athletes, the amount of such remodeling was independently associated to higher peak oxygen pulse (p<0.001) and weakly with greater RV Global Longitudinal Strain reserve (p=0.03). Conclusions:We were able to identify specific bi-ventricular regional remodeling induced by long-lasting endurance training. The amount of remodeling was associated with better cardiopulmonary performance during an exercise test.

Exercise Capacity in Young Adults Born Small for Gestational Age

“…Whereas on the left side of the heart, an increased volume output can be established without much change in LV pressure, the pulmonary circulation is too short to provide volume buffering, resulting in important changes in RV pressure during exercise. 31 Indeed, the observed RV basal and septal shape remodeling in adults born SGA shares some similarities with those found in sportsinduced remodeling, 10,31 although the population born SGA in our study did not exercise more (often on the contrary) than their control counterparts. The observed remodeling may indicate that the RV of adults born SGA would be regularly subjected to higher pressures, suggesting that the pressure increase with moderate exercise would be larger in these adults compared with adults born at normal weight.…”

“…19 Ventricular shape differences between those born SGA and controls were assessed by SSA. 7,10,20 Statistical shape analysis was used to compute a reference shape for each population (controls and SGA) separately to compare them. Next, the specific remodeling in each individual (biventricular remodeling score) was estimated.…”

“…The aforementioned studies used classical measurements on echocardiography or cardiac magnetic resonance (CMR) imaging but not contemporary techniques, such as statistical shape analysis (SSA), which enables the performance of statistical analyses directly on cardiac structures as a single object and the ability to study regional shape variability in a population. This technique has allowed for the identification of specific ventricular regional remodeling in athletes, hypertension in pregnancy, adults born preterm, and preadolescents born SGA . Thus, applying SSA may help to better describe the pattern of cardiac remodeling in adults born SGA.…”

Right Ventricular Global and Regional Remodeling in American-Style Football Athletes: A Longitudinal 3D Echocardiographic Study

“…Considering the RV outlet, it was previously demonstrated that this region could be exposed to high wall stress during exercise [25] and that the occurrence of ventricular tachycardia of outflow tract origin could be part of the physiological remodeling process in athletes [26]. Nevertheless, the RV outlet enlargement was inconstantly associated with exercise training [8,24,27,28]. Even when using 3D echocardiography-derived cross-sectional planes, the endocardial border tracings to outline the RV outflow tract and the pulmonary valve position remain challenging, as shown by our reproducibility analysis.…”

Moderately trained male football players, compared to sedentary male adults, exhibit anatomical but not functional cardiac remodelling, a cross-sectional study

“…The volume load of endurance exercise is a stimulus to the excentric hypertrophy seen in sports with a high dynamic component [ 26 , 27 ]. Previous categorization of sports in terms of their propensity to induce cardiac remodelling has been questioned and newer studies put more emphasis on the individual training intensity and duration, expressed as fitness that can be objectively measured in a maximal cardiopulmonary exercise test allowing the quantification of maximal oxygen consumption, VO 2 max [ 28 ]. Earlier studies have shown a close correlation between the level of fitness and cardiac chamber sizes as well as LVM [ 29 ] which we also found in this study, further supported by findings in linear LV-dimensions.…”