Journal of Cardiovascular Development and Disease

Research

12 pages, 922 KiB

Open AccessArticle

Cardiac Structure and Cardiorespiratory Fitness in Young Male Japanese Rugby Athletes

by Yoshitaka Iso, Hitomi Kitai, Keiko Ichimori, Megumi Kubota, Miki Tsujiuchi, Sakura Nagumo, Tsutomu Toshida, Toru Yonechi, Mio Ebato and Hiroshi Suzuki

J. Cardiovasc. Dev. Dis. 2023, 10(1), 12; https://doi.org/10.3390/jcdd10010012 - 1 Jan 2023

Cited by 1 | Viewed by 1741

Abstract

Limited data are available on athlete’s heart for rugby athletes. This study aimed to investigate cardiac structure and its relationship with cardiorespiratory fitness in young Japanese rugby athletes. A prospective cross-sectional study using echocardiography and cardiopulmonary exercise testing (CPET) was conducted on 114 [...] Read more.

Limited data are available on athlete’s heart for rugby athletes. This study aimed to investigate cardiac structure and its relationship with cardiorespiratory fitness in young Japanese rugby athletes. A prospective cross-sectional study using echocardiography and cardiopulmonary exercise testing (CPET) was conducted on 114 male collegiate rugby players. There was a higher prevalence of increased left ventricular (LV), atrial, and aortic dimensions in the young athletes than that in previously published reports, whereas the wall thickness was within the normal range. Anthropometry and CPET analyses indicated that the forwards and backs presented muscular and endurance phenotypes, respectively. Indexed LV and aortic dimensions were significantly larger in the backs than in the forwards, and the dimensions significantly correlated with oxygen uptake measured by CPET. On the four-tiered classification for LV hypertrophy, abnormal LV geometry was found in 16% of the athletes. Notably, the resting systolic blood pressure was significantly higher in athletes with concentric abnormal geometry than in the other geometry groups, regardless of their field positions. Japanese young athletes may exhibit unique phenotypes of cardiac remodeling in association with their fitness characteristics. The four-tiered LV geometry classification potentially offers information regarding the subclinical cardiovascular risks of young athletes. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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10 pages, 1408 KiB

Open AccessArticle

Systolic Blood Pressure Response to Exercise in Endurance Athletes in Relation to Oxygen Uptake, Work Rate and Normative Values

by Anna Carlén, Gustaf Eklund, August Andersson, Carl-Johan Carlhäll, Magnus Ekström and Kristofer Hedman

J. Cardiovasc. Dev. Dis. 2022, 9(7), 227; https://doi.org/10.3390/jcdd9070227 - 15 Jul 2022

Cited by 4 | Viewed by 2697

Abstract

Work rate has a direct impact on the systolic blood pressure (SBP) during aerobic exercise, which may be challenging in the evaluation of the SBP response in athletes reaching high work rates. We aimed to investigate the exercise SBP response in endurance athletes [...] Read more.

Work rate has a direct impact on the systolic blood pressure (SBP) during aerobic exercise, which may be challenging in the evaluation of the SBP response in athletes reaching high work rates. We aimed to investigate the exercise SBP response in endurance athletes in relation to oxygen uptake (VO₂), work rate and to recent reference equations for exercise SBP in the general population. Endurance athletes with a left-ventricular end-diastolic diameter above the reference one performed a maximal bicycle cardiopulmonary exercise test. The increase in SBP during exercise was divided by the increase in VO₂ (SBP/VO₂ slope) and in Watts, respectively (SBP/W slope). The maximum SBP (SBP_max) and the SBP/W slope were compared to the predicted values. In total, 27 athletes (59% men) were included; mean age, 40 ± 10 years; mean VO_2max, 50 ± 5 mL/kg/min. The mean SBP/VO₂ slope was 29.8 ± 10.2 mm Hg/L/min, and the mean SBP/W slope was 0.27 ± 0.08 mm Hg/W. Compared to the predicted normative values, athletes had, on average, a 12.2 ± 17.6 mm Hg higher SBP_max and a 0.12 ± 0.08 mm Hg/W less steep SBP/W slope (p < 0.01 and p < 0.001, respectively). In conclusion, the higher SBP_max values and the less steep SBP/W slope highlight the importance of considering work rate when interpreting the SBP response in endurance athletes and suggest a need for specific normative values in athletes to help clinicians distinguish physiologically high maximal blood pressure from a pathological blood pressure response. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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Review

Jump to: Research, Other

11 pages, 1005 KiB

Open AccessReview

The Complex but Fascinating Relationship between Sport and Atrial Fibrillation: From Pathophysiology to the Clinical Scenario

by Mario Tatangelo, Marco Rebecchi, Marianna Sgueglia, Alessandra Colella, Cinzia Crescenzi, Germana Panattoni, Pellegrino Ciampi, Oreste Lanza, Emanuele Canali and Leonardo Calò

J. Cardiovasc. Dev. Dis. 2023, 10(6), 255; https://doi.org/10.3390/jcdd10060255 - 11 Jun 2023

Cited by 2 | Viewed by 3199

Abstract

Atrial fibrillation (AF) is the most common cause of hospital admission among all arrhythmias in the general population. Moreover, AF represents the most common arrhythmia in the athletic population as well. The complex but fascinating relationship between sport and atrial fibrillation has not [...] Read more.

Atrial fibrillation (AF) is the most common cause of hospital admission among all arrhythmias in the general population. Moreover, AF represents the most common arrhythmia in the athletic population as well. The complex but fascinating relationship between sport and atrial fibrillation has not yet been fully clarified. Although the benefits of moderate physical activity in controlling cardiovascular risk factors and in reducing the risk of atrial fibrillation have been widely demonstrated, some concerns have been raised about the potential adverse effects of physical activity. Endurance activity in middle-aged men athletes appears to increase the risk of AF. Several different physiopathological mechanisms may explain the increased risk of AF in endurance athletes, including the imbalance of the autonomic nervous system, changes in left atrial size and function and presence of atrial fibrosis. The goal of this article is to review the epidemiology, pathophysiology and clinical management for AF in athletes, including pharmacological and electrophysiological strategies. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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10 pages, 1485 KiB

Open AccessReview

The Cardiac Effects of COVID-19 on Young Competitive Athletes: Results from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA)

by Nathaniel Moulson, Bradley J. Petek, Aaron L. Baggish, Kimberly G. Harmon, Stephanie A. Kliethermes, Manesh R. Patel, Timothy W. Churchill and Jonathan A. Drezner

J. Cardiovasc. Dev. Dis. 2023, 10(2), 72; https://doi.org/10.3390/jcdd10020072 - 6 Feb 2023

Cited by 6 | Viewed by 2838

Abstract

The Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study is a large-scale prospective investigation evaluating the cardiovascular effects and outcomes of SARS-CoV-2 infection on young competitive athletes. This review provides an overview of the key results from the ORCCA study. Results from [...] Read more.

The Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study is a large-scale prospective investigation evaluating the cardiovascular effects and outcomes of SARS-CoV-2 infection on young competitive athletes. This review provides an overview of the key results from the ORCCA study. Results from the ORCCA study have provided important insights into the clinical impact of SARS-CoV-2 infection on the cardiovascular health of young competitive athletes and informed contemporary screening and return to sport practices. Key results include defining a low prevalence of both cardiac involvement and adverse cardiovascular outcomes after SARS-CoV-2 infection and evaluating the utility of a return-to-play cardiac evaluation. Future aims of the ORCCA study include the longer-term evaluation of cardiovascular outcomes among athletes post-SARS-CoV-2 infection and the transition to investigating outcomes in young athletes with potentially high-risk genetic or structural cardiac diagnoses. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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16 pages, 4791 KiB

Open AccessReview

Sudden Cardiac Death in Athletes: Facts and Fallacies

by Jennie Han, Andrea Lalario, Enzo Merro, Gianfranco Sinagra, Sanjay Sharma, Michael Papadakis and Gherardo Finocchiaro

J. Cardiovasc. Dev. Dis. 2023, 10(2), 68; https://doi.org/10.3390/jcdd10020068 - 5 Feb 2023

Cited by 9 | Viewed by 10056

Abstract

The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary [...] Read more.

The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary artery disease predominates in individuals of >35 years of age, primary cardiomyopathies and ion channelopathies are prevalent in young individuals. Prevention of SCD in athletes relies on the implementation of health policies aimed at the early identification of arrhythmogenic diseases (such as cardiac screening) and successful resuscitation (such as widespread utilization of automatic external defibrillators and training members of the public on cardiopulmonary resuscitation). This review will focus on the epidemiology and aetiologies of SCD in athletes, and examine fallacies in the approach to this controversial field. Furthermore, potential strategies to prevent these tragic events will be discussed, analysing current practice, gaps in knowledge and future directions. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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24 pages, 8730 KiB

Open AccessReview

Certainties and Uncertainties of Cardiac Magnetic Resonance Imaging in Athletes

by Liliana Szabo, Giulia Brunetti, Alberto Cipriani, Vencel Juhasz, Francesca Graziano, Kristof Hirschberg, Zsofia Dohy, Dorottya Balla, Zsofia Drobni, Martina Perazzolo Marra, Domenico Corrado, Bela Merkely, Alessandro Zorzi and Hajnalka Vago

J. Cardiovasc. Dev. Dis. 2022, 9(10), 361; https://doi.org/10.3390/jcdd9100361 - 20 Oct 2022

Cited by 6 | Viewed by 2880

Abstract

Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden [...] Read more.

Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible imaging modality that can help differentiate athlete’s heart from cardiomyopathy. CMR allows accurate characterization of the morphology and function of cardiac chambers, providing full coverage of the ventricles. Moreover, it permits an in-depth understanding of the myocardial changes through specific techniques such as mapping or late gadolinium enhancement. In this narrative review, we will focus on the certainties and uncertainties of the role of CMR in sports cardiology. The main aspects of physiological adaptation due to regular and intensive sports activity and the application of CMR in highly trained athletes will be summarized. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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20 pages, 2926 KiB

Open AccessReview

May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review

by Francesca Graziano, Vencel Juhasz, Giulia Brunetti, Alberto Cipriani, Liliana Szabo, Béla Merkely, Domenico Corrado, Flavio D’Ascenzi, Hajnalka Vago and Alessandro Zorzi

J. Cardiovasc. Dev. Dis. 2022, 9(10), 347; https://doi.org/10.3390/jcdd9100347 - 10 Oct 2022

Cited by 11 | Viewed by 2948

Abstract

The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise [...] Read more.

The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise would be beneficial compared to a sedentary lifestyle, while very high-dose physical activity would paradoxically be detrimental. We reviewed the available evidence on the potential adverse effects of very intense, prolonged exercise on the cardiovascular system, both acute and chronic, in healthy athletes without pre-existing cardiovascular conditions. We found that endurance sports activities may cause reversible electrocardiographic changes, ventricular dysfunction, and troponin elevation with complete recovery within a few days. The theory that repeated bouts of acute stress on the heart may lead to chronic myocardial damage remains to be demonstrated. However, male veteran athletes with a long sports career show an increased prevalence of cardiovascular abnormalities such as electrical conduction delay, atrial fibrillation, myocardial fibrosis, and coronary calcifications compared to non-athletes. It must be underlined that the cause–effect relationship between such abnormalities and the exercise and, most importantly, the prognostic relevance of such findings remains to be established. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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Other

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7 pages, 2240 KiB

Open AccessCase Report

Myocardial Bridging Leading to Cardiac Collapse in a Marathon Runner

by André Alexandre, Pinheiro Vieira, André Dias-Frias, Anaisa Pereira, Andreia Campinas, David Sá-Couto, Bruno Brochado, Isabel Sá, João Silveira and Severo Torres

J. Cardiovasc. Dev. Dis. 2022, 9(7), 200; https://doi.org/10.3390/jcdd9070200 - 24 Jun 2022

Cited by 2 | Viewed by 5152

Abstract

Myocardial bridging (MB) is a congenital coronary anomaly, which is defined as cardiac muscle overlying a portion of a coronary artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB. Sports medicine recognizes MB as a [...] Read more.

Myocardial bridging (MB) is a congenital coronary anomaly, which is defined as cardiac muscle overlying a portion of a coronary artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB. Sports medicine recognizes MB as a cause of sudden death among young athletes. We present a case of a 30-year-old man who suddenly collapsed during a marathon running. Diagnostic workup with coronary computed tomography angiography revealed the presence of three simultaneous myocardial bridges in this patient, possibly explaining the exercise-induced syncope. The other diagnostic tests excluded seizures, cranioencephalic lesions, ionic or metabolic disturbances, acute coronary syndromes, cardiomyopathies, myocarditis, or conduction disturbances. Exertional syncope is a high-risk complaint in the marathon runner. In the context of intense physical activity, the increased sympathetic tone leading to tachycardia and increased myocardial contractility facilitates MB ischemia. In this illustrative case, the patient’s syncope might probably be associated with an ischemia-induced arrhythmia secondary to MB and potentiated by dehydration in the context of prolonged stress (marathon running). In conclusion, this case highlights that MB may be associated with dangerous complications (myocardial ischemia and life-threatening ventricular arrhythmias), particularly during intense physical activity and in the presence of a long myocardial bridge. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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16 pages, 737 KiB

Open AccessSystematic Review

The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

by Angus J. Davis, Christopher Semsarian, John W. Orchard, Andre La Gerche and Jessica J. Orchard

J. Cardiovasc. Dev. Dis. 2022, 9(6), 183; https://doi.org/10.3390/jcdd9060183 - 8 Jun 2022

Cited by 3 | Viewed by 3635

Abstract

Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A [...] Read more.

Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A systematic review was conducted of the MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science databases, for papers that assessed athlete screening ECGs and compared findings on the basis of ethnicity. Fifty-one papers which compared ECGs from various ethnicities were included. Most studies assessed Black athletes against Caucasian athletes and found a greater prevalence of T-wave inversion (TWI) (2.6–22.8% vs. 0–5.0%) and anterior TWI (3.7–14.3% vs. 0.6–2.0%). Black athlete subgroups in Africa had TWI (20–40%) and anterior TWI (4.3–18.7%) at a higher prevalence than other Black athletes. Athletes who were defined as mixed-race, Asian, and Pacific Islander are potentially more like Black athletes than Caucasian athletes. Black ethnicity is known to have an impact on the accurate interpretation of athlete ECGs; however, there is nuance related to origin of both parents. Asian and Pacific Islander origin also may impact athlete ECG interpretation. Further research is required to assist in distinguishing abnormal and normal athlete ECGs in different ethnic populations. Full article

(This article belongs to the Special Issue Cardiovascular Disease in Athletes)

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