Subscribe to RSS
DOI: 10.1055/a-1014-2994
Echocardiographic Assessment of Left Ventricular Remodeling in American Style Footballers
Publication History
accepted 19 August 2019
Publication Date:
02 December 2019 (online)
Abstract
Several athletic programs incorporate echocardiography during pre-participation screening of American Style Football (ASF) players with great variability in reported echocardiographic values. Pre-participation screening was performed in National Collegiate Athletic Association Division I ASF players from 2008 to 2016 at the Division of Sports Cardiology. The echocardiographic protocol focused on left ventricular (LV) mass, mass-to-volume ratio, sphericity, ejection fraction, and longitudinal Lagrangian strain. LV mass was calculated using the area-length method in end-diastole and end-systole. A total of two hundred and thirty players were included (18±1 years, 57% were Caucasian, body mass index 29±4 kg/m2) after four players (2%) were excluded for pathological findings. Although there was no difference in indexed LV mass by race (Caucasian 78±11 vs. African American 81±10 g/m2, p=0.089) or sphericity (Caucasian 1.81±0.13 vs. African American 1.78±0.14, p=0.130), the mass-to-volume ratio was higher in African Americans (0.91±0.09 vs. 0.83±0.08, p<0.001). No race-specific differences were noted in LV longitudinal Lagrangian strain. Player position appeared to have a limited role in defining LV remodeling. In conclusion, significant echocardiographic differences were observed in mass-to-volume ratio between African American and Caucasian players. These demographics should be considered as part of pre-participation screening.
-
References
- 1 Mont L, Pelliccia A, Sharma S. 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: 139-163
- 2 Vitarelli A, Capotosto L, Placanica G. et al. Comprehensive assessment of biventricular function and aortic stiffness in athletes with different forms of training by three-dimensional echocardiography and strain imaging. Eur Heart J Cardiovasc Imaging 2013; 14: 1010-1020
- 3 Pelliccia A, Maron BJ, Spataro A. et al. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991; 324: 295-301
- 4 Pelliccia A, Culasso F, Di Paolo FM. et al. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 1999; 130: 23-31
- 5 Croft LB, Belanger A, Miller MA. et al. Comparison of National Football League linemen versus nonlinemen of left ventricular mass and left atrial size. Am J Cardiol 2008; 102: 343-347
- 6 Khan AA, Safi L, Wood M. Cardiac imaging in athletes. Methodist Debakey Cardiovasc J 2016; 12: 86-92
- 7 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
- 8 Schiros CG, Ahmed MI, Sanagala T. et al. Importance of three-dimensional geometric analysis in the assessment of the athlete’s heart. Am J Cardiol 2013; 1067-1072
- 9 De Castro S, Caselli S, Maron M. et al. Left ventricular remodelling index (LVRI) in various pathophysiological conditions: A real-time three-dimensional echocardiographic study. Heart 2007; 93: 205-209
- 10 Lin J, Wang F, Weiner RB. et al. Blood pressure and LV remodeling among American-style football players. JACC Cardiovasc Imaging 2016; 9: 1367-76
- 11 Kooreman Z, Giraldeau G, Finocchiaro G. et al. Athletic remodeling in female college athletes, the “Morganroth Hypothesis” revisited. Clin J Sport Med 2019; 29: 224-231
- 12 Crouse SF, White S, Erwin JP. Echocardiographic and blood pressure characteristics of first-year collegiate American-style football players. Am J Cardiol 2016; 117: 131-134
- 13 Wyman RA, Chiu RY, Rahko PS. et al. The 5-minute screening echocardiogram for athletes. J Am Soc Echocardiogr 2008; 21: 786-788
- 14 Weiner RB, Wang F, Hutter AM. et al. The feasibility, diagnostic yield, and learning curve of portable echocardiography for out-of-hospital cardiovascular disease screening. J Am Soc Echocardiogr 2012; 25: 568-575
- 15 Maron BJ, Winkel BG, Tfelt-Hansen J. et al. Perspectives on cardiovascular screening. JAMA 2015; 313: 31-32
- 16 Lang RM, Badano LP, Mor-Avi V. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: e14
- 17 Engel DJ, Schwartz A, Homma S. Athletic cardiac remodeling in US professional basketball players. JAMA Cardiol 2016; 1: 80-87
- 18 Uberoi A, Sadik J, Lipinski MJ. et al. Association between cardiac dimensions and athlete lineup position: Analysis using echocardiography in NCAA football team players. Phys Sportsmed 2013; 41: 58-66
- 19 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
- 20 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
- 21 Dumesnil JG, Shoucri RM, Laurenceau JL. et al. A mathematical model of the dynamic geometry of the intact left ventricle and its application to clinical data. Circulation 1979; 59: 1024-1034
- 22 Kobayashi Y, Ariyama M, Kobayashi Y. et al. Comparison of left ventricular manual versus automated derived longitudinal strain: Implications for clinical practice and research. Int J Cardiovasc Imaging 2016; 32: 429-437
- 23 Rogers WJ, Shapiro EP, Weiss JL. et al. Quantification of and correction for left ventricular systolic long-axis shortening by magnetic resonance tissue tagging and slice isolation. Circulation 1991; 84: 721-731
- 24 Russo C, Hahn RT, Jin Z. et al. Comparison of echocardiographic single-plane versus biplane method in the assessment of left atrial volume and validation by real time three-dimensional echocardiography. J Am Soc Echocardiogr 2010; 23: 954-960
- 25 Nagueh SF, Smiseth OA, Appleton CP. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277-314
- 26 Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987; 317: 1098
- 27 Kishi S, Reis JP, Venkatesh BA. et al. Race-ethnic and sex differences in left ventricular structure and function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. J Am Heart Assoc 2015; 4: e001264
- 28 Drazner MH, Dries DL, Peshock RM. et al. Left ventricular hypertrophy is more prevalent in blacks than whites in the general population: The Dallas Heart Study. Hypertension 2005; 46: 124-129
- 29 Natori S, Lai S, Paul Finn J. et al. Cardiovascular function in multi-ethnic study of atherosclerosis: Normal values by age, sex, and ethnicity. AJR Am J Roentgenol 2006; 186: S357-365
- 30 Pelà G, Li Calzi M, Crocamo A. et al. Ethnicity-related variations of left ventricular remodeling in adolescent amateur football players. Scand J Med Sci Sports 2015; 25: 382-389
- 31 Caselli S, Di Paolo FM, Pisicchio C. et al. Three-dimensional echocardiographic characterization of left ventricular remodeling in Olympic athletes. Am J Cardiol 2011; 108: 141-147
- 32 Russo C, Jin Z, Homma S. et al. Race-ethnic differences in subclinical left ventricular systolic dysfunction by global longitudinal strain: A community-based cohort study. Am Heart J 2015; 169: 721-726
- 33 Spirito P, Pelliccia A, Proschan MA. et al. Morphology of the “athlete’s heart” assessed by echocardiography in 947 elite athletes representing 27 sports. Am J Cardiol 1994; 74: 802-806
- 34 Weiner RB, Wang F, Isaacs SK. et al. Blood pressure and left ventricular hypertrophy during American-style football participation. Circulation 2013; 128: 524-531
- 35 George KP, Birch KM, Pennell DJ. et al. Magnetic-resonance-imaging-derived indices for the normalization of left ventricular morphology by body size. Magn Reson Imaging 2009; 27: 207-213
- 36 La Gerche A, Burns AT, Taylor AJ. et al. Maximal oxygen consumption is best predicted by measures of cardiac size rather than function in healthy adults. Eur J Appl Physiol 2012; 112: 2139-2147
- 37 Beaudry R, Haykowsky MJ, Baggish A. et al. A modern definition of the athlete’s heart—for research and the clinic. Cardiol Clin 2016; 34: 507-514
- 38 Tischler MD, Niggel J, Borowski DT. et al. Relation between left ventricular shape and exercise capacity in patients with left ventricular dysfunction. J Am Coll Cardiol 1993; 22: 751-757
- 39 Levine YC, Matos J, Rosenberg MA. et al. Left ventricular sphericity independently predicts appropriate implantable cardioverter-defibrillator therapy. Heart Rhythm 2016; 13: 490-497
- 40 Choi JH, Sung J. Left ventricular sphericity index in asymptomatic population. J Cardiovasc Ultrasound 2009; 17: 54-59
- 41 Petersen SE, Aung N, Sanghvi MM. et al. Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort. J Cardiovasc Magn Reson 2017; 19: 18
- 42 Paffenbarger RS, Kampert JB, Lee IM. et al. Physical activity and health of college men: longitudinal observations. Int J Sports Med 1997; 18 (Suppl 3) S200-203
- 43 Allen TW, Vogel RA, Lincoln AE. et al. Body size, body composition, and cardiovascular disease risk factors in NFL players. Phys Sportsmed 2010; 38: 21-27
- 44 Tucker AM, Vogel RA, Lincoln AE. et al. Prevalence of cardiovascular disease risk factors among National Football League players. JAMA 2009; 301: 2111-2119
- 45 Hedman K, Moneghetti KJ, Christle JW. et al. Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling. Heart 2019; 105: 1223-1230
- 46 Whelton PK, Carey RM, Aronow WS. et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology, American Heart Association; Task Force on Clinical Practi. KIDNEYS 2018; 7: 68-74 doi:10.22141/2307-1257.7.1.2018.122220
- 47 Farsalinos KE, Daraban AM, Ünlü S. et al. Head-to-head comparison of global longitudinal strain measurements among nine different vendors: The EACVI/ASE Inter-Vendor Comparison Study. J Am Soc Echocardiogr 2015; 28 (1171/1181) e2