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Fibrosis in endurance athletes

Sandra Pujadas, Maite Doñate, Chi-Hion Li, Soraya Merchan, Ana Cabanillas, Xavier Alomar, Guillem Pons-Llado, Ricard Serra-Grima, Francesc Carreras
There is still some controversy about the benignity of structural changes observed in athlete's heart, especially regarding the observation of increased biomarkers and the presence of myocardial fibrosis (MF). Aim: Our purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes. Methods: Thirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR...
2018: BMJ Open Sport & Exercise Medicine
Bradley J Petek, Meagan M Wasfy
PURPOSE OF REVIEW: The number of female athletes participating in sports has increased exponentially over the past century. While cardiac adaptations to exercise have been well described, female athletes have been underrepresented in many prior studies. More recently, important research has embraced gender as an important biologic variable. We will review this work in order to examine how gender influences the impact of exercise on the heart. RECENT FINDINGS: Exercise-induced cardiac remodeling (EICR) manifests slightly differently in male and female athletes...
July 18, 2018: Current Treatment Options in Cardiovascular Medicine
Luigi Gabrielli, Marta Sitges, Mario Chiong, Jorge Jalil, María Ocaranza, Silvana Llevaneras, Sebastian Herrera, Rodrigo Fernandez, Rodrigo Saavedra, Fernando Yañez, Luis Vergara, Alexis Diaz, Sergio Lavandero, Pablo Castro
Moderate endurance exercise has long been considered an essential element to maintain cardiovascular health, and sedentary behaviour in the general population has been related to a significant increase in all-causes of mortality, cardiovascular disease mortality and cardiovascular disease incidence. However, a growing group of people performs an intense exercise that leads to multiple heart adaptive changes that are collectively called "athlete's heart". In this review, we discussed the evidence of cardiac remodelling process secondary to repetitive and strenuous exercise in some predisposed athletes that produces intense and probably deleterious changes in cardiac morphology and function with no clear clinical significance in long-term follow-up...
October 2018: European Journal of Sport Science
Axel Pressler, Angelika Jähnig, Martin Halle, Bernhard Haller
OBJECTIVE: Exaggerated blood pressure (BP) response to exercise testing has been linked to left ventricular hypertrophy and myocardial fibrosis in competitive athletes. Due to frequent training, athletes are particularly exposed to high BP levels, but data on the magnitude and distribution of BP response to exercise in athletic populations is scarce. METHODS: Cycle ergometry was performed in 2419 healthy competitive adolescent, professional and master athletes (age 26 ± 12 years, range 9-74, 27% women, 84 disciplines) for preparticipation screening...
September 2018: Journal of Hypertension
N A Mark Estes, Christopher Madias
Although the cardiovascular benefits of moderate exercise are well established, there is growing epidemiological support for the notion that high-intensity endurance athletics increases the risk of atrial fibrillation (AF). There are many gaps in evidence related to epidemiology and mechanisms of AF in endurance athletes. The proposed pathophysiological mechanisms include alterations of autonomic tone, electrical remodeling, anatomical remodeling, fibrosis, and inflammation. Clinical management of the athlete with AF often includes a period of decreased frequency, intensity, and duration of exercise with assessment for improvement in AF recurrence...
September 2017: JACC. Clinical Electrophysiology
Guido Claessen, Frédéric Schnell, Jan Bogaert, Mathias Claeys, Nele Pattyn, Frederik De Buck, Steven Dymarkowski, Piet Claus, Francois Carré, Johan Van Cleemput, Andre La Gerche, Hein Heidbuchel
Aims: The distinction between left ventricular (LV) dilation with mildly reduced LV ejection fraction (EF) in response to regular endurance exercise training and an early cardiomyopathy is a frequently encountered and difficult clinical conundrum. We hypothesized that exercise rather than resting measures would provide better discrimination between physiological and pathological LV remodelling and that preserved exercise capacity does not exclude significant LV damage. Methods and results: We prospectively included 19 subjects with LVEF between 40 and 52%, comprising 10 ostensibly healthy endurance athletes (EA-healthy) and nine patients with dilated cardiomyopathy (DCM)...
September 1, 2018: European Heart Journal Cardiovascular Imaging
Douglas Lewis, Andrew Blow, Jonathan Tye, Tamara Hew-Butler
Exercise-associated hyponatraemia (EAH) always involves a component of overhydration relative to available exchangeable sodium stores. In the majority of cases, this is purely due to excessive consumption of fluids during exercise. In a lesser number of cases, it is apparent that excessive sodium loss through sweat may play a role by decreasing the amount of acutely available exchangeable sodium. Two cases demonstrating the latter, one in an individual with cystic fibrosis (CF) and another in an endurance athlete without CF, demonstrate how elevated dermal sweat losses may contribute to a relative dilutional EAH along a pathophysiological continuum...
March 9, 2018: BMJ Case Reports
Aaron L Baggish
No abstract text is available yet for this article.
September 2018: JACC. Cardiovascular Imaging
Timothy W Churchill, Aaron L Baggish
Cardiovascular remodeling in response to sustained moderate and high-intensity exercise is a well-established phenomenon. Following more than a century of work focused on the left ventricle (LV), remodeling of the right side of the heart has recently become a topic of considerable scientific and clinical interest. Morphologic and functional changes have now been well documented in the right ventricle (RV) after isolated bouts of endurance exercise and in association with long-term sustained training. Although exercise-induced cardiac remodeling is classically viewed as an adaptive, clinically benign process, it has recently been hypothesized that repetitive bouts of intense exercise may trigger pathologic changes in the RV characterized by patchy fibrosis and a predisposition to arrhythmia...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
Thijs M H Eijsvogels, David L Oxborough, Rory O'Hanlon, Sanjay Sharma, Sanjay Prasad, Greg Whyte, Keith P George, Mathew G Wilson
The aim of the present study was to compare cardiac structure as well as global and regional cardiac function in athletes with and without myocardial fibrosis (MF). Cardiac magnetic resonance imaging with late gadolinium enhancement was used to detect MF and global cardiac structure in nine lifelong veteran endurance athletes (58 ± 5 years, 43 ± 5 years of training). Transthoracic echocardiography using tissue-Doppler and myocardial strain imaging assessed global and regional (18 segments) longitudinal left ventricular function...
November 2017: European Journal of Sport Science
Emma Roca, Lexa Nescolarde, Josep Lupón, Jaume Barallat, James L Januzzi, Peter Liu, M Cruz Pastor, Antoni Bayes-Genis
The number of recreational/non-elite athletes participating in marathons is increasing, but data regarding impact of endurance exercise on cardiovascular health are conflicting. This study evaluated 79 recreational athletes of the 2016 Barcelona Marathon (72% men; mean age 39 ± 6 years; 71% ≥35 years). Blood samples were collected at baseline (24-48 h before the race), immediately after the race (1-2 h after the race), and 48-h post-race. Amino-terminal pro-B type natriuretic peptide (NT-proBNP, a marker of myocardial strain), ST2 (a marker of extracellular matrix remodeling and fibrosis, inflammation, and myocardial strain), and high-sensitivity troponin T (hs-TnT, a marker of myocyte stress/injury) were assayed...
April 2017: Journal of Cardiovascular Translational Research
Mohit K Turagam, Greg C Flaker, Poonam Velagapudi, Sirisha Vadali, Martin A Alpert
Atrial fibrillation (AF) is the most common cardiac arrhythmia in athletes, especially in middle-aged athletes. Studies have demonstrated that athletes who engage in endurance sports such as runners, cyclists and skiers are more prone to AF than other athletes. The effects of exercise on the onset and progression of AF is complex. Triggers of AF in athletes may include atrial ectopy and sports supplements. Substrates for AF in athletes include atrial remodeling, fibrosis, and inflammation. Modulators of AF in athletes include autonomic activation, electrolyte abnormalities, and possibly, gastroesophageal reflux...
December 2015: Journal of Atrial Fibrillation
Eduard Guasch, Lluís Mont
The cardiovascular benefits of physical activity are indisputable. Nevertheless, growing evidence suggests that both atrial fibrillation and right ventricular arrhythmia can be caused by intense exercise in some individuals. Exercise-induced atrial fibrillation is most commonly diagnosed in middle-aged, otherwise healthy men who have been engaged in endurance training for >10 years, and is mediated by atrial dilatation, parasympathetic enhancement, and possibly atrial fibrosis. Cardiac ablation is evolving as a first-line tool for athletes with exercise-induced arrhythmia who are eager to remain active...
February 2017: Nature Reviews. Cardiology
Fabian Sanchis-Gomar, Marta López-Ramón, Rafael Alis, Nuria Garatachea, Helios Pareja-Galeano, Alejandro Santos-Lozano, Pilar Catalán, Veronica Sansoni, Silvia Perego, Giovanni Lombardi, Herbert Löllgen, Hector Bueno, Enrique Serrano-Ostáriz, Alejandro Lucia
BACKGROUND: The impact of high exercise loads on a previously healthy heart remains controversial. We examined the consequences of decades of strenuous endurance exercise at the highest competition level on heart dimensions and volumes as well as on serum biomarkers of cardiac fibrosis/remodeling. METHODS AND RESULTS: We compared echocardiographic measurements and serum biomarkers of cardiac fibrosis/remodeling [troponin I, galectin-3, matrix metallopeptidase-2 and -9, N-terminal pro-brain natriuretic peptide, carboxy-terminal propeptide of type I procollagen, and soluble suppressor of tumorigenicity-2 (sST-2)/interleukin(IL)-1R4] in 53 male athletes [11 former professional ('elite') and 42 amateur-level ('sub-elite') cyclists or runners, aged 40-70years] and 18 aged-matched controls...
November 1, 2016: International Journal of Cardiology
G F Veraldi, M Macrì, P Criscenti, L Scorsone, C C Zingaretti, M Gnoni, L Mezzetto
External Iliac Artery Endofibrosis (EIAE) is an uncommon disease usually affecting young, otherwise healthy, patients. It usually involves cyclists but cases have been reported in other groups of endurance athletes. The external iliac artery is the most affected anatomical site but other locations are described too. The precise pathophysiology and long-term evolution of the disease still remain unknown. The diagnosis may be challenging and delayed as the patients usually present symptoms only in extreme conditions and physical and instrumental examinations may be normal at rest...
November 2015: Il Giornale di Chirurgia
Nikolaos Fragakis, Gabriele Vicedomini, Carlo Pappone
There is evidence for a higher prevalence of atrial fibrillation (AF) in athletes engaged in long-term endurance sports training compared with the general population. Although atrial anatomic adaptations, alterations in autonomic nervous system, chronic systemic inflammation and fibrosis have been proposed as potential mechanisms, they remain speculative. Medical therapy with long-term antiarrhythmic agents or 'pill in the pocket' medications is hampered by limitations, such as sports eligibility and interference with exercise tolerance...
May 2014: Arrhythmia & Electrophysiology Review
Flavio D'Ascenzi, Matteo Cameli, Marco M Ciccone, Maria Maiello, Pietro A Modesti, Sergio Mondillo, Maria L Muiesan, Pietro Scicchitano, Salvatore Novo, Pasquale Palmiero, Pier S Saba, Roberto Pedrinelli
Atrial fibrillation is the most common clinically significant arrhythmia observed both in the general population and in competitive athletes. The most important risk factors are all preventable by regular physical activity. However, although the benefits of moderate physical activity in controlling cardiovascular risk factors and decreasing the risk of atrial fibrillation have been extensively proved, concerns have arisen about the potential negative effects of vigorous exercise, particularly in endurance athletes...
December 2015: Journal of Cardiovascular Medicine
Dina Christina Janse van Rensburg, Audrey Jansen van Rensburg, Elsa Margaretha van Duuren, Catharina Cornelia Grant
Exercise-induced iliac artery endofibrosis is a recently described abnormality of the external iliac artery that typically affects younger, healthy endurance athletes. Characteristic of the initially termed cyclist's iliac syndrome is lower limb pain during exercise with rapid recovery after exercise. This clinically complicated case describes an older female long-distance runner in whom an incorrect diagnosis of fibromuscular dysplasia was originally made when she presented with claudication and thrombosis of the right external iliac artery...
December 2014: American Journal of Physical Medicine & Rehabilitation
Olivier Rouvière, Patrick Feugier, John Palma Gutiérrez, Jean-Michel Chevalier
PURPOSE: To describe the spectrum of angiographic features of arterial endofibrosis and to assess the patterns of associated lesions. MATERIALS AND METHODS: This retrospective study was compliant with the declaration of Helsinki principles. Files of patients who underwent surgery between January 1998 and December 2009 were retrospectively searched for histologic analysis-proven arterial endofibrosis. Preoperative angiograms were read in consensus by two radiologists...
October 2014: Radiology
Judy K Clifft, F Ann Coleman, Casey B Malone
The purpose of this case report was to alert the physical therapist (PT) to the possibility of vascular disorders in endurance athletes with apparent musculoskeletal symptoms. A 33-year-old female injured her knee in a fall and described a history of progressive unilateral lower extremity (LE) pain and weakness, especially with running and cycling. She received LE stretching and strengthening but her symptoms persisted, so she stopped all activity. When she became symptomatic with minimal exertion, she went to a neurologist, but electromyographic (EMG)/nerve conduction velocity (NCV) studies were normal...
October 2014: Physiotherapy Theory and Practice
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