Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2019

Open Access 01-12-2019 | Echocardiography | Research article

The influence of LV geometry on the occurrence of abnormal exercise tests in athletes

Authors: Danny A. J. P. van de Sande, Jan Hoogsteen, Pieter A. Doevendans, Hareld M. C. Kemps

Published in: BMC Cardiovascular Disorders | Issue 1/2019

Login to get access

Abstract

Background

Previous studies revealed a high rate of abnormal exercise test (ET) results in the absence of obstructive coronary artery disease (CAD) in asymptomatic athletes. The physiological background of this phenomenon is not well established. In particular, it is unclear whether sports-induced morphological cardiac adaptations are determinants of abnormal ET results. The main objective of this study was to investigate if healthy asymptomatic recreational and competitive athletes with abnormal ET results without obstructive CAD have a higher LV mass when compared with athletes with normal ET results.

Methods

Seventy-three athletes with abnormal ET results without presence of obstructive CAD underwent echocardiographic assessment of LV mass, systolic and diastolic measurements. These data were compared with data from 73 athletes with normal ET results, matched for gender, age, body composition, sports characteristics and exercise capacity.

Results

No significant increase in LV mass (161.9 ± 39 g vs. 166.9 ± 42.1 g, p = 0.461) was found between groups. Athletes with abnormal ET results had a significant thicker IVSd (9.7 ± 1.8 mm vs. 9.0 ± 1.7 mm, p = 0.014), higher IVSd/PWTd ratio (1.08 ± 0.20 vs. 1.00 ± 0.12, p = 0.011) and deceleration time (DT) was prolonged ((225.14 ± 55.08 vs. 199.96 ± 34.65, p = 0.003).

Conclusion

Athletes with abnormal ET result did not show a higher in LV mass when compared to athletes with a normal ET result. However, a pattern of asymmetric cardiac remodeling, together with altered diastolic function is present. Due to small differences, cardiac remodeling only plays a limited role in the occurrence of positive ET results in athletes.
Literature
1.
go back to reference Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 2: Preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American heart Associ. J Am Coll Cardiol. 2015;66:2356–61. https://doi.org/10.1016/j.jacc.2015.09.034.CrossRefPubMed Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 2: Preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American heart Associ. J Am Coll Cardiol. 2015;66:2356–61. https://​doi.​org/​10.​1016/​j.​jacc.​2015.​09.​034.CrossRefPubMed
2.
go back to reference Corrado D, Schmied C, Basso C, Borjesson M, Schiavon M, Pelliccia A, et al. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J. 2011;32:934–44.CrossRef Corrado D, Schmied C, Basso C, Borjesson M, Schiavon M, Pelliccia A, et al. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J. 2011;32:934–44.CrossRef
3.
go back to reference Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes. JAMA. 2006;296:1593–601.CrossRef Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes. JAMA. 2006;296:1593–601.CrossRef
5.
go back to reference Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017;69:1057–75.CrossRef Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017;69:1057–75.CrossRef
6.
go back to reference Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace. 2017;19:139–63.CrossRef Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace. 2017;19:139–63.CrossRef
7.
go back to reference Gibbons LW, Mitchell TL, Wei M, Blair SN, Cooper KH. Maximal exercise test as a predictor of risk for mortality from coronary heart disease in asymptomatic men. Am J Cardiol. 2000;86:53–8.CrossRef Gibbons LW, Mitchell TL, Wei M, Blair SN, Cooper KH. Maximal exercise test as a predictor of risk for mortality from coronary heart disease in asymptomatic men. Am J Cardiol. 2000;86:53–8.CrossRef
9.
go back to reference van de Sande DAJP, Breuer MAW, Kemps HMC. Utility of Exercise electrocardiography in pre-participation screening in asymptomatic athletes: a systematic review. Sport Med. 2016;46:1155–64.CrossRef van de Sande DAJP, Breuer MAW, Kemps HMC. Utility of Exercise electrocardiography in pre-participation screening in asymptomatic athletes: a systematic review. Sport Med. 2016;46:1155–64.CrossRef
10.
go back to reference Shimizu M, Ino H, Okeie K, Emoto Y, Yamaguchi M, Yasuda T, et al. Exercise-induced ST-segment depression and systolic dysfunction in patients with nonobstructive hypertrophic cardiomyopathy. Am Heart J. 2000;140:52–60.CrossRef Shimizu M, Ino H, Okeie K, Emoto Y, Yamaguchi M, Yasuda T, et al. Exercise-induced ST-segment depression and systolic dysfunction in patients with nonobstructive hypertrophic cardiomyopathy. Am Heart J. 2000;140:52–60.CrossRef
14.
go back to reference Laaksonen MS, Heinonen I, Luotolahti M, Knuuti J, Kalliokoski KK. V̇O2peak, myocardial hypertrophy, and myocardial blood flow in endurance-trained men. Med Sci Sports Exerc. 2014;46:1498–505.CrossRef Laaksonen MS, Heinonen I, Luotolahti M, Knuuti J, Kalliokoski KK. V̇O2peak, myocardial hypertrophy, and myocardial blood flow in endurance-trained men. Med Sci Sports Exerc. 2014;46:1498–505.CrossRef
15.
go back to reference van Middelkoop M, van Linschoten R, Berger MY, Koes BW, Bierma-Zeinstra SM. Knee complaints seen in general practice: active sport participants versus non-sport participants. BMC Musculoskelet Disord. 2008;9:36.CrossRef van Middelkoop M, van Linschoten R, Berger MY, Koes BW, Bierma-Zeinstra SM. Knee complaints seen in general practice: active sport participants versus non-sport participants. BMC Musculoskelet Disord. 2008;9:36.CrossRef
17.
go back to reference Mitchell JH, Haskell W, Snell P, Van Camp SP, Exercise RTO. Task force 8: Classi cation of sports. Response. 2005;45:1364–7. Mitchell JH, Haskell W, Snell P, Van Camp SP, Exercise RTO. Task force 8: Classi cation of sports. Response. 2005;45:1364–7.
18.
go back to reference Oh JK, Seward J, Tajik A. The Echo manual, 3th edition. Wolters Kluwer; 2006. Oh JK, Seward J, Tajik A. The Echo manual, 3th edition. Wolters Kluwer; 2006.
19.
go back to reference Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–71. https://doi.org/10.1093/ehjci/jev014.CrossRefPubMed Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–71. https://​doi.​org/​10.​1093/​ehjci/​jev014.CrossRefPubMed
22.
go back to reference Arts F, Kuipers H. The relation between power output, oxygen uptake and heart rate in male athletes. Int J Sports Med. 1994;15:228–31.CrossRef Arts F, Kuipers H. The relation between power output, oxygen uptake and heart rate in male athletes. Int J Sports Med. 1994;15:228–31.CrossRef
23.
go back to reference Rodrigues JCL, Amadu AM, Dastidar AG, Hassan N, Lyen SM, Lawton CB, et al. Prevalence and predictors of asymmetric hypertensive heart disease: insights from cardiac and aortic function with cardiovascular magnetic resonance. Eur Hear J – Cardiovasc Imaging. 2016;17:1405–13. https://doi.org/10.1093/ehjci/jev329.CrossRef Rodrigues JCL, Amadu AM, Dastidar AG, Hassan N, Lyen SM, Lawton CB, et al. Prevalence and predictors of asymmetric hypertensive heart disease: insights from cardiac and aortic function with cardiovascular magnetic resonance. Eur Hear J – Cardiovasc Imaging. 2016;17:1405–13. https://​doi.​org/​10.​1093/​ehjci/​jev329.CrossRef
28.
go back to reference Jacobs T, Bell R, McClements J. Exercise, age and the development of the myocardial vasculature. Growth. 1984;48:148–57.PubMed Jacobs T, Bell R, McClements J. Exercise, age and the development of the myocardial vasculature. Growth. 1984;48:148–57.PubMed
31.
go back to reference Toraa M, Pouillard F, Merlet P, Friemel F. Cardiac hypertrophy and coronary reserve in endurance athletes. Can J Appl Physiol. 1999;24:87–95.PubMed Toraa M, Pouillard F, Merlet P, Friemel F. Cardiac hypertrophy and coronary reserve in endurance athletes. Can J Appl Physiol. 1999;24:87–95.PubMed
32.
go back to reference Heinonen I, Nesterov SV, Liukko K, Kemppainen J, Någren K, Luotolahti M, et al. Myocardial blood flow and adenosine A2Areceptor density in endurance athletes and untrained men. J Physiol. 2008;586:5193–202.CrossRef Heinonen I, Nesterov SV, Liukko K, Kemppainen J, Någren K, Luotolahti M, et al. Myocardial blood flow and adenosine A2Areceptor density in endurance athletes and untrained men. J Physiol. 2008;586:5193–202.CrossRef
33.
go back to reference Heinonen I, Kudomi N, Kemppainen J, Kiviniemi A, Noponen T, Luotolahti M, et al. Myocardial blood flow and its transit time, oxygen utilization, and efficiency of highly endurance-trained human heart. Basic Res Cardiol. 2014;109. Heinonen I, Kudomi N, Kemppainen J, Kiviniemi A, Noponen T, Luotolahti M, et al. Myocardial blood flow and its transit time, oxygen utilization, and efficiency of highly endurance-trained human heart. Basic Res Cardiol. 2014;109.
34.
go back to reference Rawlins J, Bhan A, Sharma S. Left ventricular hypertrophy in athletes. Eur J Echocardiogr. 2009;10:350–6.CrossRef Rawlins J, Bhan A, Sharma S. Left ventricular hypertrophy in athletes. Eur J Echocardiogr. 2009;10:350–6.CrossRef
38.
go back to reference Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials: a report from the american society of echocardiography’s guidelines and standards committee and the task force on echocardiography in clinical trials. J Am Soc Echocardiogr. 2004;17:1086–119.PubMed Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials: a report from the american society of echocardiography’s guidelines and standards committee and the task force on echocardiography in clinical trials. J Am Soc Echocardiogr. 2004;17:1086–119.PubMed
Metadata
Title
The influence of LV geometry on the occurrence of abnormal exercise tests in athletes
Authors
Danny A. J. P. van de Sande
Jan Hoogsteen
Pieter A. Doevendans
Hareld M. C. Kemps
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2019
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-018-0983-1

Other articles of this Issue 1/2019

BMC Cardiovascular Disorders 1/2019 Go to the issue