CARDIAC BENEFICIAL EFFECTS AND ADAPTATIONS IN ATHLETES

Transcription

1 ARISTOTLE UNIVERSITY OF THESSALONIKI, GREECE SPORTS MEDICINE LABORATORY DIRECTOR: PROF. A. DELIGIANNIS CARDIAC BENEFICIAL EFFECTS AND ADAPTATIONS IN ATHLETES ASTERIOS DELIGIANNIS CARDIOLOGIST PROFESSOR OF SPORTS MEDICINE

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3 Hippocrates B.C. Eating alone will not keep a man well; he must also take exercise. For food and exercise work together to produce health

4 PHYSICAL ACTIVITY IS BENEFICIAL FOR CARDIAC HEALTH

5 Gielen S et al. Circulation 2010; 122:

6 EXERCISE INCREASES AEROBIC CAPACITY Q = SV x HR VO2 MAX=Q χ A-V O2

7 Deligiannis et al,science and Health,42,2002

8 IMPROVEMENT OF AEROBIC CAPACITY IN CAD PATIENTS BY 1 ΜΕΤ CAUSES 10% REDUCTION OF MORTALITY. Franklin: J Cardiovasc Nurs 2003; 18(2):

9 Lab. Aristotle University of of Thessaloniki

10 EXERCISE TRAINING AND ENDOTHELIAL FUNCTION EXERCISE TRAINING BLOOD FLOW SHEAR STRESS mrna EXPRESSION OF NOS SYNTHESIS AND RELEASE OF NO Sports Medicine Lab VASODILATATION Kouidi EHJ 2008; 49: 231-

11 Effects of athletic training on heart rate variability ATHLETE SEDENTARY Kouidi E. et al, Clin Physiol Funct Imag 2002

12 EFFECTS OF EXERCISE TRAINING ON BAROREFLEX SENSITIVITY BRS (ms/mmhg) BEI (%) Petraki M et al Clin Nephrol 2008

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14 TRAINING AND LIPIDS PROFILE Nutrition, Μetabolism & Cardiovascular Diseases 2006;16:

15 Primary Prevention Preventing a target condition, such as heart disease General health promotion efforts

16 ARE SPORTS BENEFICIAL OR DANGEROUS FOR THE CARDIAC HEALTH? Sudden Cardiac Death of Pheidippides

17 ATHLETE S HEART OR ATHLETIC HEART SYNDROME

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20 Dynamic exercise requires volume work, producing left ventricular hypertrophy (LVH) and chamber dilatation (eccentric LVH), whereas isometric exercise involves pressure work, producing increased wall thickness without chamber dilatation (concentric LVH)

21 Έκκεντρη Συγκεντρική Mihl C, et al Neth Heart J 2008;16:129-33

22 THE MAJOR SIGNALING PATHWAYS INVOLVED IN CARDIAC HYPERTROPHY Bernardo B, et al. Pharmacology & Therapeutics 2010; 128:

23 DYNAMIC EXERCISE AND CARDIAC CHAMBERS DILATATION Nottin S, et al J Physiol 2008; 586:

24 CARDIAC HYPERTROPHY MODEL AFTERLOAD SYSTOLIC WALL STRESS NUMBER OF RIBOSOMES PROTEIN SYNTHESIS ( camp-protein KINASE) WALL HYPERTROPHY SYSTOLIC WALL STRESS P x r (wall stress= ) 2h

25 CARDIAC STRACTURAL ADAPTATIONS IN ATHLETES Left ventricular end-diastolic diameter was increased by 10% compared with controls, which represents a 33% increase in volume. Septal thickness and posterior wall thickness increased by 15% and 20%. Right ventricular diastolic diameter increased by 25%. Left ventricular mass increased by 45% Deligiannis et al,science and Health,42,2002

26 Dancing with the Doping to Cardiac Death!!! A.Deligiannis, Lisbon, 2014

27 . Effect of specific sports training on LV cavity dimension or wall thickness in elite athletes, representing 27 different sporting disciplines. Maron B J, and Pelliccia A Circulation. 2006;114:

28 Naylor LH et al. Sports Med 2008; 38 (1): 69-90

29 . Distribution of cardiac dimensions in large populations of highly trained male and female athletes. Maron B J, and Pelliccia A Circulation. 2006;114:

30 CARDIAC ADAPTATIONS IN ATHLETES ANATOMICAL LV wall thickness LV and RV diastolic dimension Atrial dimension LV mass FUNCTIONAL SV-CO Normal filling parameters Supranormal diastolic function ELECTRICAL Sinus bradycardia Sinus pause AV block first degree, type I sec degree P wave changes QRS voltage of LVH T wave changes in precordial leads

31 Physiological remodeling of the athlete's heart and pathological remodeling in settings of disease lead to different cardiac morphologies. Weeks K L, and McMullen J R Physiology 2011;26:97-105

32 Key morphological and functional differences between the athlete's heart and the failing heart. Weeks K L, and McMullen J R Physiology 2011;26:97-105

33 The dilemma remains

34 10 REASONS WHY AN ATHLETE S HEART IS USUALLY NOT DANGEROUS

35 1. ATHLETE S WITH LARGE HEARTS TEND TO HAVE EXCELLENT CARDIAC FUNCTION

36 ATHLETIC CARDIAC HYPERTROPHY NORMAL SYSTOLIC CONTRACTILITY NO FIBROSIS NORMAL (OR INCREASED?) SARCOPLASMIC RETICULUM FUNCTION ABNORMAL ELECTROPHYSIOLOGICAL PROPERTIES NORMAL (OR IMPROVED?) DIASTOLIC FUNCTION Deligiannis A.,Sports Med,62,2008

37 Cardiac Functional Adaptations in Athletes Left ventricular systolic function appears to be normal in athletes, both when measured at rest and during exercise R. Fagard, Heart 2003

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41 Hoogsteen J et al. Int J Cardiovasc Imaging 2004 ; 20(1):19-26.

42 Left ventricular diastolic function is on average normal at rest, but is enhanced during exercise which favours adequate filling of the ventricle at high heart rates. JF Lewis, at al. Br Heart J 1992

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47 From: Athlete's Heart: The Potential for Multimodality Imaging to Address the Critical Remaining Questions J Am Coll Cardiol Img. 2009;2(3): doi: /j.jcmg y.

48 2. ATHLETE S HEART IS NOT ENTIRELY PERMANENT

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50 . Cardiac remodeling caused by long-term deconditioning. Maron B J, and Pelliccia A Circulation. 2006;114:

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52 3. ATHLETE S HEARTS ARE SYMMETRICAL AND UNIFORM

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54 Figure 1 End-diastolic T 1 -weighted short-axis slice from an endurance athlete (left) and an untrained control subject (right). Compared with the heart of the control subject, the endurance athlete s heart is characterized by an enlarged volume and a... Jürgen Scharhag, Günther Schneider, Axel Urhausen, Veneta Rochette, Bernhard Kramann, Wilfried Kindermann Athlete s heart : Right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging Journal of the American College of Cardiology, Volume 40, Issue 10, 2002,

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57 Luthi P, et al. Eur J Echocardiogr 2008; 9(2):261-7.

58 . The relative impact of different sports disciplines on aortic dimension. Pelliccia A et al. Circulation. 2010;122:

59 . Two-dimensional echocardiogram in parasternal long-axis plane with schematic drawings from an elite basketball player (aged 22 years) A, Aortic dimension is 42 mm at initial evaluation. Pelliccia A et al. Circulation. 2010;122:698-

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61 4. ATHLETE S HEARTS ARE WELL VASCULARIZED

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63 EXERCISE AND ARTERIES REMODELING Brown MD, Exp Physiol 2003; 88:

64 MBF (ml min 1 g 1) at rest (A) and during adenosine-induced hyperaemia (B) in hypertensive patients with LVH (n=15), semi-professional triathletes with LVH (n=15), professional football players (n=15), and sedentary individuals (n=15). Indermühle A et al. Eur Heart J 2006;27:

65 ARTERIAL COMPLIANCE AND β-stiffness INDEX Circulation 2000; 102: 1270-

66 Carotid-femoral pulse wave velocity (PWV) in athletes 1 p < 0,05 vs group HSA 2 p < 0,01 vs group CRL PWV (m/sec) RDA HDA : high level athletes of dynamic sports, RDA: recreational athletes of dynamic sports, HSA : high level athletes of static sports, RSA : recreational athletes of static sports, CRL: control group

67 5. CORONARY ARTERIES ARE GENERALLY LARGER IN ATHLETES

68 Green D et al. Exp Physiol 2012; 97:

69 CORONARY ARTERIES IN ATHLETES

70 6. ATHLETE S HEART IS NOT CUMULATIVE

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72 7. ATHLETE S WITH BIG HEARTS ARE USUALLY ASYMPTOMATIC

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74 8. ATHLETE S HEARTS USUALLY HAVE HEALTHY MITOCHONDRIA Kouidi E.,Sports Med, 32, 1997

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76 Schematic representation of signalling pathways that may influence mitochondrial function in physiological and pathological cardiac hypertrophy. Abel E D, and Doenst T Cardiovasc Res 2011;cvr.cvr015

77 9. ATHLETE S HEART IS LARGELY CAUSED BY DIFFERENT GENES AND SIGNALING PATHWAYS THAN HEART DISEASE

78 . Impact of different clinical variables on LV end-diastolic cavity dimensions in a large population of male and female elite athletes. Maron B J, and Pelliccia A Circulation. 2006;114:

79 Overview of key signaling pathways involved in mediating LV hypertrophy of the athlete's heart and the diseased myocardium Ang II, angiotensin II; ET-1, endothelin-1; GPCR, G protein-coupled receptor; HCM, hypertrophic cardiomyopathy; IGF1, insulin-like gro... Weeks K L, and McMullen J R Physiology 2011;26:97-105

80 10. ELITE ATHLETES LIVE A LONG TIME

81 Age-adjusted mortality rates in healthy men categorized by level of fitness. Myers J Circulation. 2003;107:e2-e5

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85 BENEFITS AND RISKS OF EXERCISE

86 TOO MUCH EXERCISE CAN BE BAD FOR THE HEART!

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88 TAKE HOME MESSAGE 1!

89 TAKE HOME MESSAGE 2!