Influencing Factors of Cardiac Adaptation in Adolescent Athletes

Dora Szabo; Dora Nagy; Csaba Melczer; Pongrac Acs; Laszlo Ratgeber; Istvan Szokodi; Miklos Toth; Attila Cziraki; Kata Eklics; Zsolt Sarszegi

doi:10.1055/a-1386-4805

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2021; 42(13): 1209-1221
DOI: 10.1055/a-1386-4805

Clinical Sciences

Influencing Factors of Cardiac Adaptation in Adolescent Athletes

Dora Szabo

¹Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary

,

Dora Nagy

²Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary

,

Csaba Melczer

²Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary

,

Pongrac Acs

²Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary

,

Laszlo Ratgeber

²Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary

,

Istvan Szokodi

¹Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary

,

Miklos Toth

³Szentagothai Research Centre , University of Pecs, Pecs, Hungary

,

Attila Cziraki

¹Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary

,

Kata Eklics

⁴Department of Languages for Biomedical Purposes, University of Pecs, Pecs, Hungary

,

Zsolt Sarszegi

¹Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary

› Author Affiliations

Abstract

Endurance training-induced changes in left ventricular diastolic function and right ventricular parameters have been investigated extensively in adolescent athletes. Our aim was to examine the parameters for adolescent athletes (n=121, 15.1±1.6 years) compared to adult athletes and age-matched non-athletes. We explored the effects of influencing factors on the echocardiographic parameters. Significantly higher E/A (p<0.05) and e’ values (p<0.001) were detected in adolescent athletes compared to age-matched non-athletes’ and also adult athletes’ parameters. Significantly lower structural and functional right ventricular parameters (p<0.05) were detected in adult athletes. In adolescent athletes significantly higher right ventricular diameters, tricuspid S wave, right ventricular end-diastolic and end-systolic area values (p<0.05) were found compared to the matching parameters of non-athletes. We found significantly higher corrected tricuspid annular plane systolic excursion values (p<0.001) in athletes compared to the non-athletes. Based on multivariate analysis lean body mass, body surface area, age and cumulative training time were proved as strong predictive factors of both left ventricular diastolic and right ventricular parameters. Supernormal left ventricular diastolic function and significantly higher right ventricular parameters are indicative of cardiac adaptation. Well-defined cut-off values should be applied to discriminate pathological conditions in the relation of the influencing factors.

Key words

left ventricular diastolic function - right ventricular parameters - echocardiography - sports cardiology

Full Text

References

References
1 Morganroth J, Maron BJ, Henry WL. et al. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 1975; 82: 521-524
2 D’ Andrea A, Formisano T, Scarafile R. et al. Acute and chronic response to exercise in athletes: The “supernormal heart”. Adv Exp Med Biol 2017; 999: 21-41
3 Donal E, Rozoy T, Kervio G. et al. Comparison of the heart function adaptation in trained and sedentary men after 50 and before 35 years of age. Am J Cardiol 2011; 108: 1029-1037
4 Prakken NH, Cramer NJ, Teske AJ. et al. The effect of age in the cardiac MRI evaluation of the athlete’s heart. Int J Cardiol 2011; 149: 68-73
5 Pelliccia A, Culasso F, Di Paolo FM. et al. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 1999; 130: 23-31
6 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
7 Caselli S, Di Paolo FM, Pisicchio C. et al. Three-dimensional echocardiographic characterization of left ventricular remodeling in Olympic athletes 2011; 108: 141-147
8 Pelliccia A, Caselli S, Sharma S. et al. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: Recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart. Eur Heart J 2018; 39: 1949-1969
9 Morganroth J, Maron BJ, Henry WL. et al. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 1975; 82: 521-524
10 Pelliccia A, Maron MS, Maron BJ. Assessment of left ventricular hypertrophy in a trained athlete: differential diagnosis of physiologic athlete’s heart from pathologic hypertrophy. Prog Cardiovasc Dis 2012; 54: 387-396
11 Maron BJ, Peliccia A, Spirito P. Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 1995; 91: 1596-1601
12 D'Ascenzi F, Solari M, Anselmi F. et al. Atrial chamber remodelling in healthy pre-adolescent athletes engaged in endurance sports: A study with a longitudinal design. The CHILD study. Int J Cardiol 2016; 15: 325-330
13 D'Ascenzi F. Echocardiographic evaluation of paediatric athlete’s heart. Eur J Prev Cardiol 2018; 25: 1202-1203
14 Krysztofiak H, Młyńczak M, Folga A. et al. Normal values for left ventricular mass in relation to lean body mass in child and adolescent athletes. Pediatr Cardiol 2019; 40: 204-208
15 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. Eur Heart J Cardiovasc Imaging 2016; 17: 1321-1360
16 Voelkel NF, Quaife RA, Leinwand LA. et al. Right ventricular function and failure: Report of a National Heart, Lung and Blood Institute working group on cellular and molecular mechanism of right heart failure. Circulation 2006; 114: 1883-1891
17 Caselli S, Di Paolo FM, Pisicchio C. et al. Patterns of left ventricular diastolic function in Olympic athletes. J Am Soc Echocardiogr 2015; 28: 236-244
18 D'Ascenzi F, Cameli M, Zacà V. et al. Supernormal diastolic function and role of left atrial myocardial deformation analysis by 2D speckle tracking echocardiography in elite soccer players. Echocardiography 2011; 28: 320-326
19 Pluim BM, Zwinderman AH, van der Laarse A. et al. The athlete’s heart. A meta-analysis of cardiac structure and function. Circulation 2000; 25: 336-344
20 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
21 D’Ascenzi F, Pelliccia A, Solari M. et al. Normative reference values of right heart in competitive athletes: a systematic review and meta-analysis. J Am Soc Echocardiogr 2017; 30: 845-858.e2
22 D'Ascenzi F, Pelliccia A, Valentini F. et al. Training-induced right ventricular remodelling in pre-adolescent endurance athletes: The athlete’s heart in children. Int J Cardiol 2017; 236: 270-275
23 Popple E, George K, Somauroo J. et al. Right ventricular structure and function in senior and academy elite footballers. Scand J Med Sci Sports 2018; 28: 2617-2624
24 Harriss DJ, Macsween A, Atkinson G. Ethical Standards in Sport and Exercise Science Research: 2020 Update. Int J Sports Med 2019; 40: 813-817
25 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: 233-271
26 Colan SD. Normal echocardiographic values for cardiovascular structures. In: Lai WW, Mertens LI, Cohen MS, Geva T. Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult. Second Ed.. New Jersey: John Wiley & Sons; 2016: 883-901
27 Koestenberger M, Ravekes W, Nagel B. et al. Reference values of the right ventricular outflow tract systolic excursion in 711 healthy children and calculation of z-score values. Eur Heart J Cardiovasc Imaging 2014; 15: 980-986
28 Cantinotti M, Scalese M, Murzi B. et al. Echocardiographic nomograms for chamber diameters and areas in caucasian children. J Am Soc Echocardiogr 2014; 27: 1279-1292
29 D’Ascenzi F, Cameli M, Padeletti M. et al. Characterization of right atrial function and dimension in top-level athletes: a speckle tracking study. Int J Cardiovasc Imaging 2013; 29: 87-94
30 Zaidi A, Ghani S, Sharma R. et al. Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation 2013; 127: 1783-1792
31 D’Andrea A, Riegler L, Golia E. et al. Range of right heart measurements in top-level athletes: The training impact. Int J Cardiol 2013; 164: 48-57
32 D’Andrea A, Riegler L, Morra S. et al. Right ventricular morphology and function in top-level athletes: A three-dimensional echocardiographic study. J Am Soc Echocardiogr 2013; 25: 1268-1276
33 Beaumont AJ, Grace FM, Richards JC. et al. Aerobic Training Protects Cardiac Function During Advancing Age: A meta-analysis of four decades of controlled studies. Sports Med 2019; 49: 199-219
34 Lazic JS, Tadic M, Antic M. et al. The relationship between right heart and aerobic capacity in large cohort of young elite athletes. Int J Cardiovasc Imaging 2019; 35: 1027-1036