Exercise Training Induces Left- but not Right-sided Cardiac Remodelling in Olympic Rowers

Abstract

Whilst the athlete’s heart has been extensively described, less work has focused on the potential for elite athletes to demonstrate further cardiac remodelling upon an increase in training volume. Moreover, little work explored potential side-specific cardiac remodelling. Therefore, we examined the impact of an increase in training volume across 9-months in elite rowers on left- and right-sided cardiac structure, function and mechanics (i. e. longitudinal, radial and circumferential strain, twist and strain-volume loops). As part of the preparations to the 2012 Olympic Games, twenty-seven elite rowers (26.4±3.7years, 19 male) underwent echocardiography prior to and post (9 months) an increase in training volume (24 to 30–35 h weekly). Training increased left ventricular structure, including wall thickness, diameter, volume, mass and LV twist (all p<0.05). Female rowers demonstrated larger adaptation in left ventricular diameter and mass compared to male rowers (both p<0.05). No changes were observed in other measures of left ventricular function in both sexes (all p>0.05). The 9-month intervention showed no change in right ventricular/atrial structure, function or mechanics (all p>0.05). In conclusion, our data revealed that 9-month increased training volume in elite rowers induced left-sided (but not right-sided) structural remodelling, concomitant with an increase in left ventricular twist, with some changes larger in women.

Key words

athlete’s heart - right ventricle - cardiovascular disease - echocardiography - speckle tracking echocardiography

Publikationsverlauf

Eingereicht: 10. November 2020

Angenommen: 25. Mai 2021

Artikel online veröffentlicht:
10. August 2021

• References

• 1 Utomi V, Oxborough D, Whyte GP. et al. Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart. Heart 2013; 99: 1727-1733 doi:10.1136/heartjnl-2012-303465
• 2 Spence AL, Naylor LH, Carter HH. et al. A prospective randomised longitudinal MRI study of left ventricular adaptation to endurance and resistance exercise training in humans. J Physiol 2011; 589: 5443-5452 doi:10.1113/jphysiol.2011.217125
• 3 Anderson RH, Razavi R, Taylor AM. Cardiac anatomy revisited. J Anat 2004; 205: 159-177 doi:10.1111/j.0021-8782.2004.00330.x
• 4 La Gerche A, Heidbuchel H, Burns AT. et al. Disproportionate exercise load and remodeling of the athlete's right ventricle. Med Sci Sports Exerc 2011; 43: 974-981 doi:10.1249/MSS.0b013e31820607a3
• 5 La Gerche A, Burns AT, Mooney DJ. et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J 2012; 33: 998-1006 doi:10.1093/eurheartj/ehr397
• 6 La Gerche A, Claessen G, Dymarkowski S. et al. Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes. Eur Heart J 2015; 36: 1998-2010 doi:10.1093/eurheartj/ehv202
• 7 Wheatley CM, Snyder EM, Johnson BD. et al. Sex differences in cardiovascular function during submaximal exercise in humans. Springerplus 2014; 3: 445 doi:10.1186/2193-1801-3-445
• 8 Schafer D, Gjerdalen GF, Solberg EE. et al. Sex differences in heart rate variability: A longitudinal study in international elite cross-country skiers. Eur J Appl Physiol 2015; 115: 2107-2114 doi:10.1007/s00421-015-3190-0
• 9 Colombo C, Finocchiaro G. The female athleteʼs heart: Facts and fallacies. Curr Treat Options Cardiovasc Med 2018; 20: 101 doi:10.1007/s11936-018-0699-7
• 10 Finocchiaro G, Dhutia H, D'Silva A. et al. Effect of sex and sporting discipline on LV adaptation to exercise. JACC Cardiovasc Imaging 2017; 10: 965-972 doi:10.1016/j.jcmg.2016.08.011
• 11 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817 doi:10.1055/a-1015-3123
• 12 Lang RM, Badano LP, Mor-Avi V. 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: 233-270 doi:10.1093/ehjci/jev014
• 13 Batterham AM, George KP, Whyte G. et al. Scaling cardiac structural data by body dimensions: A review of theory, practice, and problems. Int J Sports Med 1999; 20: 495-502 doi:10.1055/s-1999-8844
• 14 Oxborough D, Heemels A, Somauroo J. et al. Left and right ventricular longitudinal strain-volume/area relationships in elite athletes. Int J Cardiovasc Imaging 2016; 32: 1199-1211 doi:10.1007/s10554-016-0910-4
• 15 Hulshof HG, van Dijk AP, George KP. et al. Echocardiographic-derived strain-area loop of the right ventricle is related to pulmonary vascular resistance in pulmonary arterial hypertension. JACC Cardiovasc Imaging 2017; 10: 1286-1288 doi:10.1016/j.jcmg.2017.05.018
• 16 Oxborough D, George K, Birch KM. Intraobserver reliability of two-dimensional ultrasound derived strain imaging in the assessment of the left ventricle, right ventricle, and left atrium of healthy human hearts. Echocardiography 2012; 29: 793-802 doi:10.1111/j.1540-8175.2012.01698.x
• 17 Kleinnibbelink G, van Dijk APJ, Fornasiero A. et al. Exercise-induced cardiac fatigue after a 45-min bout of high-intensity running exercise is not altered under hypoxia. J Am Soc Echocardiogr 2021; 34: 511-521 doi:10.1016/j.echo.2020.12.003
• 18 Baggish AL, Wang F, Weiner RB. et al. Training-specific changes in cardiac structure and function: A prospective and longitudinal assessment of competitive athletes. J Appl Physiol (1985) 2008; 104: 1121-1128 doi:10.1152/japplphysiol.01170.2007
• 19 D'Ascenzi F, Cameli M, Lisi M. et al. Left atrial remodelling in competitive adolescent soccer players. Int J Sports Med 2012; 33: 795-801 doi:10.1055/s-0032-1304660
• 20 D'Ascenzi F, Pelliccia A, Natali BM. et al. Morphological and functional adaptation of left and right atria induced by training in highly trained female athletes. Circ Cardiovasc Imaging 2014; 7: 222-229 doi:10.1161/CIRCIMAGING.113.001345
• 21 Zilinski JL, Contursi ME, Isaacs SK. et al. Myocardial adaptations to recreational marathon training among middle-aged men. Circ Cardiovasc Imaging 2015; 8: e002487 doi:10.1161/CIRCIMAGING.114.002487
• 22 Weiner RB, DeLuca JR, Wang F. et al. Exercise-induced left ventricular remodeling among competitive athletes: A phasic phenomenon. Circ Cardiovasc Imaging 2015; 8: e003651 doi:10.1161/CIRCIMAGING.115.003651
• 23 D'Ascenzi F, Pelliccia A, Corrado D. et al. Right ventricular remodelling induced by exercise training in competitive athletes. Eur Heart J Cardiovasc Imaging 2016; 17: 301-307 doi:10.1093/ehjci/jev155
• 24 Aengevaeren VL, Caselli S, Pisicchio C. et al. Right heart remodeling in olympic athletes during 8 years of intensive exercise training. J Am Coll Cardiol 2018; 72: 815-817 doi:10.1016/j.jacc.2018.03.548
• 25 D'Andrea A, Riegler L, Cocchia R. et al. Left atrial volume index in highly trained athletes. Am Heart J 2010; 159: 1155-1161 doi:10.1016/j.ahj.2010.03.036
• 26 Pelliccia A, Maron BJ, Culasso F. et al. Athlete's heart in women. Echocardiographic characterization of highly trained elite female athletes. JAMA 1996; 276: 211-215 doi:10.1001/jama.276.3.211
• 27 George KP, Wolfe LA, Burggraf GW. et al. Electrocardiographic and echocardiographic characteristics of female athletes. Med Sci Sports Exerc 1995; 27: 1362-1370
• 28 Henriksen E, Landelius J, Kangro T. et al. An echocardiographic study of right and left ventricular adaptation to physical exercise in elite female orienteers. Eur Heart J 1999; 20: 309-316 doi:10.1053/euhj.1998.1197
• 29 D'Ascenzi F, Pisicchio C, Caselli S. et al. RV Remodeling in olympic athletes. JACC Cardiovasc Imaging 2017; 10: 385-393 doi:10.1016/j.jcmg.2016.03.017