The athlete's heart: A meta-analysis of cardiac structure and function

Circulation

Volumn 101, Issue 3, 2000, Pages 336-344

  Pluim, Babette M ^a,b   Zwinderman, Aeilko H ^b   Van Der Laarse, Arnoud ^a,b   Van Der Wall, Ernst E ^a,b  

^a ROYAL NETHERLANDS ACADEMY OF ARTS AND SCIENCES   (Netherlands)

^b LEIDEN UNIVERSITY MEDICAL CENTER   (Netherlands)

Author keywords

Echocardiography; Exercise; Hypertrophy; Myocardium

Indexed keywords

ADAPTATION; ATHLETE; CARDIOVASCULAR EFFECT; DYNAMIC EXERCISE; EXERCISE; HEART LEFT VENTRICLE EJECTION FRACTION; HEART LEFT VENTRICLE VOLUME; HEART LEFT VENTRICLE WALL; HEART VENTRICLE SEPTUM; HUMAN; PRIORITY JOURNAL; REVIEW; STATIC EXERCISE; TRAINING;

EID: 0034711754     PISSN: 00097322     EISSN: None     Source Type: Journal    
DOI: 10.1161/01.CIR.101.3.336     Document Type: Review

References (88)

1. Pellicia A, Maron BJ. Outer limits of the athlete's heart: the effect of gender and relevance to the differential diagnosis with primary cardiac diseases. Cardiol Clin. 1997;15:381-396.
2. Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975;82: 521-524.
3. Spirito P, Pellicia A, Proschan MA, Granata M, Spataro A, Bellone P, Caselli G, Biffi A, Vecchio C, Maron BJ. Morphology of the "athlete's heart" assessed by echocardiography in 947 elite athletes representing 27 sports. Am J Cardiol. 1994;74:802-806.
4. Pellicia A, Maron BJ, Spataro A, Proschan MA, Spirito P. The upper limit of physiologic hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324:295-301.
5. Fagard RH. Impact of different sports and training on cardiac structure and function. Cardiol Clin. 1997;15:397-412.
6. Fagard RH. Athlete's heart: a meta-analysis of the echocardiographic experience. Int J Sports Med. 1996;17:140-144.
7. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Circulation. 1977;55:613-618.
8. Dersimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-188.
9. Gilbert CA, Nutter DO, Felner JM, Perkins JV, Heymsfield SB, Schlant RC. Echocardiographic study of cardiac dimensions and function in the endurance-trained athlete. Am J Cardiol. 1977;40:528-533.
10. Underwood RH, Schwade JL. Noninvasive analysis of cardiac function of elite distance runners: echocardiography, vectorcardiography, and cardiac intervals. Ann N Y Acad Sci. 1977;301:297-309.
11. Zoneraich S, Rhee JJ, Zoneraich O, Jordan D, Appel J. Assessment of cardiac function in marathon runners by graphic noninvasive techniques. Ann N Y Acad Sci. 1977;301:900-917.
12. Parker BM, Londeree BR, Cupp GV, Dubiel JP. The noninvasive cardiac evaluation of long-distance runners. Chest. 1978;73:376-381.
13. Ikäheimo MJ, Palatsi IJ, Takkunen JT. Noninvasive evaluation of the athletic heart: sprinters versus endurance runners. Am J Cardiol. 1979; 44:24-29.
14. Longhurst JC, Kelly AR, Gonyea WJ. Echocardiographic left ventricular masses in distance runners and weight-lifters. J Appl Physiol. 1980;48: 154-162.
15. Paulsen W, Boughner DR, Ko P, Cunningham DA, Persaud JA. Left ventricular function in marathon runners: echocardiographic assessment. J Appl Physiol. 1981;51:881-886.
16. Snoeckx LHEH, Abeling HFM, Lambregts JAC, Schmitz JJF, Verstappen FTJ, Reneman RS. Cardiac dimensions in athletes in relation to variations in their training program. Eur J Appl Physiol. 1983;52:20-28.
17. Sugishita Y, Koseki S, Matsuda M, Yamaguchi T, Ito I. Myocardial mechanics of athletic hearts in comparison with diseased hearts. Am Heart J. 1983;105:273-280.
18. Child JS, Barnard RJ, Taw RL. Cardiac hypertrophy and function in master endurance runners and sprinters. J Appl Physiol. 1984;57: 176-181.
19. Fagard R, Aubert A, Staessen J, Vanden Eynde E, Vanhees L, Amery A. Cardiac structure and function in cyclists and runners. Br Heart J. 1984; 52:124-129.
20. Niemelä KO, Palatsi IJ, Ikäheimo MJ, Takkunen JT, Vuori JJ. Evidence of impaired left ventricular performance after an uninterrupted competitive 24-hour run. Circulation. 1984;3:350-356.
21. Cohen JL, Segal KR. Left ventricular hypertrophy in athletes: an exercise-echocardiographic study. Med Sci Sports Exerc. 1985;17: 695-700.
22. Granger CB, Karimeddini MK, Smith VE, Shapiro HR, Katz AM, Riba AL. Rapid ventricular filling in left ventricular hypertrophy, 1: physiologic hypertrophy. J Am Coll Cardiol. 1985;5:862-868.
23. Hagan RD, Laird WP, Gettman LR. The problems of per-surface area and per-weight standardization indices in the determination of cardiac hypertrophy in endurance-trained athletes. J Cardiopulm Rehabil. 1985;5: 554-560.
24. Spataro A, Pellicia A, Caselli G, Amici E, Venerando A. Echocardiographic standards in top-class athletes. J Sports Cardiol. 1985;2:17-27.
25. Finkelhor RS, Hanak LJ, Bahler RC. Left ventricular filling in endurance-trained subjects. J Am Coll Cardiol. 1986;8:289-293.
26. Pavlik G, Bachl N, Wollein W, Längfy G, Prokop L. Resting echocardiographic parameters after cessation of regular endurance training. Int J Sports Med. 1986;7:226-231.
27. Perrault H, Péronnet F, Lebeau R, Nadeau RA. Echocardiographic assessment of left ventricular performance before and after marathon running. Am Heart J. 1986;112:1026-1031.
28. Colan SD, Sanders SP, Borow KM. Physiologic hypertrophy: effects on left ventricular systolic mechanics in athletes. J Am Coll Cardiol. 1987; 9:776-783.
29. Roy A, Doyon M, Dumesnil JG, Jobin J, Landry F. Endurance vs strength training: comparison of cardiac structures using normal predicted values. J Appl Physiol. 1988;64:2552-2557.
30. Fisher AG, Adams TD, Yanowitz FG, Ridges JD, Orsmond G, Nelson AG. Noninvasive evaluation of world class athletes engaged in different modes of training. Am J Cardiol. 1989;63:337-341.
31. MacFarlane N, Northridge DB, Wright AR, Grant S, Dargie HJ. A comparative study of left ventricular structure and function in elite athletes. Br J Sports Med. 1991;25:45-48.
32. Störk TV, Möckel M, Eichstädt H, Müller RM, Hochrein H. Noninvasive assessment by pulsed Doppler ultrasound of left ventricular filling behavior in long distance runners during marathon race. Am J Cardiol. 1991;68:1237-1241.
33. O2 max) in young men. Int J Sports Med. 1992;13:219-224.
34. Dickhuth HH, Rocker K, Heitkamp HC. Echocardiographic findings in endurance athletes with hypertrophic non-obstructive cardiomyopathy (HNCM) compared to non-athletes with HNCM and physiological hypertrophy (athlete's heart). Int J Sports Med. 1994;15:273-277.
35. Deligiannis A, Kouidi E, Milonas A. Effect of submaximal dynamic exercise on left ventricular function in endurance- and power-trained athletes. Med Sci Res. 1995;23:225-227.
36. Yeater R, Reed C, Ullrich I, Morise A, Borsch M. Resistance trained athletes using or not using anabolic steroids compared to runners: effects on cardiorespiratory variables, body composition, and plasma lipids. Br J Sports Med. 1996;30:11-14.
37. Abinader EG, Sharif D, Sagiv M, Goldhammer E. The effects of isometric stress on left ventricular filling in athletes with isometric or isotonic training compared to hypertensive and normal controls. Eur Heart J. 1996;17:457-461.
38. Karjalainen J, Mäntysaari M, Viitasalo M, Kujala U. Left ventricular mass, geometry, and filling in endurance athletes: association with exercise blood pressure. J Appl Physiol. 1997;82:531-537.
39. Nishimura T, Yamada Y, Kawai C. Echocardiographic evaluation of long-term effects of exercise on left ventricular hypertrophy and function in professional bicyclists. Circulation. 1980;61:832-840.
40. Wieling W, Borghos EAM, Hollander AP, Danner SA, Dunning AJ. Echocardiographic dimensions and maximal oxygen uptake in oarsmen during training. Br Heart J. 1981;46:190-195.
41. Bekaert I, Pannier JL, Van de Weghe C, Van Durme JP, Clement DL, Pannier R. Non-invasive evaluation of cardiac function in professional cyclists. Br Heart J. 1981;45:213-218.
42. Fagard R, Aubert A, Lysens R, Staessen J, Vanhees L, Amery A. Non-invasive assessment of seasonal variations in cardiac structure and function in cyclists. Circulation. 1983;67:896-900.
43. Abergel E, Cohen A, Vaur L, Khellaf F, Menard J, Chatellier G. Accuracy and reproducibility of left ventricular mass measurement by subcostal M-mode echocardiography in hypertensive patients and professional bicyclists. Am J Cardiol. 1993;72:620-624.
44. Agati L, Fedele F, Gagliardi MG, Sciomer S, Penco M. A super-normal behavior of echocardiographic diastolic data in athletes despite left ventricular hypertrophy. J Sports Cardiol. 1985;2:10-16.
45. Luisiani L, Ronsisvalle G, Bonamone A, Visona A, Castellani V, Macchia C, Pagnan A. Echocardiographic evaluation of the dimensions and systolic properties of the left ventricle in freshman athletes during physical training. Eur Heart J. 1986;7:196-203.
46. Fagard R, Van den Broeke C, Bielen E, Vanhees L, Amery A. Assessment of stiffness of the hypertrophied left ventricle of bicyclists using left ventricular inflow Doppler velocimetry. J Am Coll Cardiol. 1987;9:1250-1254.
47. Lo YSA, Chin MK. Echocardiographic left ventricular hypertrophy in Chinese endurance athletes. Br J Sports Med. 1990;24:274-276.
48. Lattanzi F, Spirito P, Picano E, Mazzarisi A, Landini L, Distante A, Vecchio C, L'Abbate A. Quantitative assessment of ultrasonic myocardial reflectivity in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1992;17:1085-1090.
49. Cavallaro V, Petretta M, Betocchi S, Salvatore C, Morgano G, Bianchi V, Breglio R, Bonaduce D. Effects of sustained training on left ventricular structure and function in top level rowers. Eur Heart J. 1993;14:898-903.
50. Galanti G, Comeglio M, Vinci M, Cappelli B, Vono MC, Bamoshmoosh M. Echocardiographic Doppler evaluation of left ventricular diastolic function in athletes' hypertrophied hearts. J Vasc Dis. 1993;:44:341-346.
51. Maron BJ, Pellicia A, Spataro A, Granata M. Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. Br Heart J. 1993;69:125-128.
52. Missault L, Duprez D, Jordaens L, De Bruyzere M, Bonny K, Adang L, Clement D. Cardiac anatomy and diastolic filling in professional road cyclists. Eur J Appl Physiol. 1993;66:405-408.
53. Miki T, Yokota Y, Seo T, Yokoyama M. Echocardiographic findings in 104 professional cyclists with follow-up study. Am Heart J. 1994;127:898-905.
54. Cubero GI, Reguero JJR, Tcrrados N, Gonzalez V, Barriales R, Cortina A. Aldosterone levels and cardiac hypertrophy in professional cyclists. Int J Sports Med. 1995;16:475-477.
55. Reguero JJR, Cubero GI, De la Iglesia JL, Terrados N, Gonzalez V, Cortina R, Cortina A. Prevalence and upper limit of cardiac hypertrophy in professional cyclists. Eur J Appl Physiol. 1995;70:375-378.
56. Urhausen A, Monz T, Kindermann W. Sports-specific adaptation of left ventricular mass in athlete's heart. Int J Sports Med. 1996;17:145-151.
57. Haykowsky M, Chan S, Bhambhani Y, Syrotuik D, Quinney H, Bell G. Effects of combined endurance and strength training on left ventricular morphology in male and female rowers. Can J Cardiol. 1998;14: 387-391.
58. Menapace FJ, Hammer WJ, Ritzer TF, Kessler KM, Warner HF, Spann JF, Bove AA. Left ventricular size in competitive weight lifters: an echocardioaraphic study. Med Sci Sports Exerc. 1982;14:72-75.
59. Cohen CR, Allen HD, Spain J, Marx GR, Wolfe RW, Harvey JS. Cardiac structure and function of elite high school wrestlers. Sports Med. 1987; 141:576-581.
60. Colan SD, Sanders SP, MacPherson D, Borow KM. Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy. J Am Coll Cardiol. 1985;6:545-549.
61. Salke RC, Rowland TW, Burke EJ. Left ventricular size and function in body builders using anabolic steroids. Med Sci Sports Exerc. 1985;17: 701-704.
62. Pearson AC, Schiff M, Mrosek D, Labovitz AJ, Williams GA. Left ventricular diastolic function in weight lifters. Am J Cardiol. 1986;58: 1254-1259.
63. Brown SP, Thompson WR. Standardization indices of cardiac hypertrophy in weight lifters. J Sport Sci. 1987;5:147-153.
64. Van den Broeke C, Fagard R. Left ventricular structure and function, assessed by imaging and Doppler echocardiography, in athletes engaged in throwing events. Int J Sports Med. 1988;9:407-411.
65. Urhausen A, Kindermann W. One- and two-dimensional echocardiography in body builders and endurance-trained subjects. Int J Sports Med. 1989;10:139-144.
66. Thompson PD, Sadaniantz A, Cullilane EM, Bodziony KS, Catlin DH, Torek-Both G, Douglas PS. Left ventricular function is not impaired in weight-lifters who use anabolic steroids. J Am Coll Cardiol. 1992;19: 278-282.
67. Pellicia A, Spataro A, Caselli G, Maron BJ. Absence of left ventricular wall thickening in athletes engaged in intense power training. Am J Cardiol. 1993;72:1048-1054.
68. Dickhuth HH, Simon G, Kindermann W, Wildberg A, Keul J. Echokardiographische Untersuchungen bei Sportlern verschiedener Sportarten und Untrainierten. Z Kardiol. 1979;68:449-453.
69. Mumford M, Prakash R. Electrocardiographs and echocardiographic characteristics of long distance runners. Am J Sports Med. 1981;9:23-28.
70. Shapiro LM, Moore RB, Logan-Sinclair RB, Gibson DG. Relation of regional echo amplitude to left ventricular function and the electrocardiogram in left ventricular hypertrophy. Br Heart J. 1984;52:99-105.
71. Fedele F, Agati L, Penco M, Sciomer S, Gagliardi MG, Di Renzi P. 2D exercise echocardiography in athletes. J Sports Card. 1985;2:1-9.
72. Fisman EZ, Embon P, Pines A, Tenenbaum A, Drory Y, Shapiro I, Motro M. Comparison of left ventricular function using isometric exercise Doppler echocardiography in competitive runners and weight-lifters versus sedentary individuals. Am J Cardiol. 1997;79:355-359.
73. Ekblom B, Hermansen I. Cardiac output in athletes. J Appl Physiol. 1968;25:619-625.
74. Palatini P, Mos L, Di Marco A, Mormino P, Munari L, Del Torre M, Valle F, Pessina AC, Dal Palu C. Intra-arterial blood pressure recording during sports activities. J Hypertens. 1987;5:479-481.
75. McDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR. Arterial blood pressure response to heavy resistance exercise. Am J Physiol. 1985;58: 785-790.
76. MacDougall JD, McKelvie RS, Moroz DE, Sale DG, McCartney N, Buick F. Factors affecting blood pressure during heavy weight lifting and static contractions. J Appl Physiol. 1992;73:1590-1597.
77. Perez-Gonzalez JF. Factors determining the blood pressure responses to isometric exercise. Circ Res. 1981;48:76-86.
78. Vitcenda M, Hanson P, Folts J, Besozzi M. Impairment of left ventricular function during maximal isometric dead lifting. J Appl Physiol. 1990;69: 2062-2066.
79. Mitchell JH, Haskell WL, Raven PB. Classification of sports. J Am Coll Cardiol. 1994;24:864-866.
80. Clifford PS, Hanel B, Secher NH. Arterial blood pressure response to rowing. Med Sci Sports Exerc. 1994;26:715-719.
81. Shimizu G, Hirota Y, Kita Y, Kawamura K, Saito T, Gaasch WH. Left ventricular midwall mechanics in systemic arterial hypertension. Circulation. 1991;83:1676-1684.
82. Palmon L, Reichek N, Yeon SB, Clark NR, Browson D, Hoffman E, Axel L. Intramyocardial shortening in hypertensive left ventricular hypertrophy with normal pump function. Circulation. 1994;89:122-131.
83. Nishimura RA, Housmans PR, Hatle LK, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography, part 1: physiologic and pathophysiologic features. Mayo Clin Proc. 1989;64:71-81.
84. Smith VE, White WB, Karimeddini MK. Echocardiographic assessment of left ventricular diastolic performance in hypertensive subjects. Hypertension. 1987;9:81-84.
85. Fouad FM, Slominski JM, Tarazi RC. Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function. J Am Coll Cardiol. 1984;3:1500-1506.
86. Massie BM. Myocardial hypertrophy and cardiac failure: a complex interrelationship. Am J Med. 1983;72:67-74.
87. Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol. 1986;7:190-203.
88. Fagard RH. Impact of different sports and training on cardiac structure and function. Cardiol Clin. 1997;15:397-412.