Endurance training and cardiac arrhythmias

Transcription

1 Endurance training and cardiac arrhythmias Myocardial and autonomic alterations under endurance training Federico Lombardi, MD, FESC Cardiologia, Osp. San Paolo D.M.C.O. University of Milan Milan, Italy

2

3 After completing the Gran Canaria 2011 Marathon

4 Myocardial and autonomic alterations under endurance training 1) Baseline effects of endurance training/exercise 2) Effects of endurance activity during competitive racing 3) Changes in myocardial function and autonomic control mechanisms during the recovery phase

5 8 elite runners were tested after a relative resting period and after 12 weeks of intensive training. Medicine & Science in Sports & Exercise 2001

6 Effects of tilt on HRV between relative rest and intensive training period. Effects of tilt on Var and LF component of SAP variability between relative rest and intensive training period. Medicine & Science in Sports & Exercise 2001

7 11 initially sedentary subjects were trained for a year in order to complete a marathon. TRIMP: duration of training session * HR achieved during the session weighted for exercise intensity according to the method of Bannister (1992). HF J Appl Physiol 2003

8 Effects of training on subject characteristics, hemodynamic and cardiovascular variability during training.

9 Dose-response relationship between monthly TRIMP and static cardiovascular indexes. J Appl Physiol 2003

10 Dose-response relationship between monthly TRIMP and dynamic cardiovascular indexes. J Appl Physiol 2003

11 In 14 moderately trained runners (36±7yrs) resting vagal-related HRV parameters were measured daily. Indices at the start of training and running performance are shown below: Eur J Appl Physiol, 2010

12 Relationship between pre- and posttraining weekly average of Ln rmssd measured at rest and maximal aerobic speed (MAS) and 10Km running performance Relationship between pre training Ln rmssdmeasured following submaximal exercise and relative changes in MAS and 10Km running performance Europ J Appl Physiol, 2010

13 LnrMMSSDrest or during recovery LN rmssdpost-ex, heart rate recovery time constant, average heart rateex and weekly training impulses Europ J Appl Physiol, 2010

14 Does LF power at peak exercise predict athletic achievement? Am J Physiol. 2010

15 Dose-response relationship between exercise intensity and autonomic cardiovascular indexes Am J Physiol. 2010

16 Dose-response relationship between exercise intensity and autonomic cardiovascular indexes and marathon time Am J Physiol. 2010

17 Older men: yr!!! Med & Scien in Sports & Exercise, 2009

18 HR at different exercise intensities before and after training

19 Short-term fractal scaling exponent α 1 at different exercise intensities before and after training Short-term fractal scaling exponent α 1 during supine rest before and after training

20 J Appl Physiol. 2010

21 Cardiac biomarkers at baseline, after crossing the finish line and recovery (24 hr after marathon)

22 J Cardiovasc Mag Res. 2010

23

24 Hanssen et al, Clinical Science 2011

25

26 Conclusions Endurance training is associated with relevant changes in autonomic control mechanisms and myocardial structure/function. The initial vagal predominance is replaced by signs of sympathetic activation at peak exercise as well as high TRIMP levels. It is also likely that the early recovery phase might be associated with a surge of vagal activity in the presence of high catecholamine levels Signs myocardial damage are commonly observed in marathon runners together with signs of reduced right ventricular function Presence of LVH and myocardial fibrosis in the context of sympathetic activation and increased O 2 consumption may favor cardiac electrical instability at atrial and ventricular level.

27 Substrates underlying sudden cardiac death u Acute Myocardial Ischemia u Extent of Myocardial injury after MI u Extent of left ventricular dysfunction in non ischemic cardiomyopathy u Genetics of arrhythmia susceptibility u The arrhythmia-prone heart: an interaction between a susceptible substrate (an anatomical defined circuit, a myocardial scar or a monogenic arrhythmia syndrome) and a triggering event (such as adrenergic surge, inflammation, acute ischemia, ). Knollmann & Roden, 2008

28 % of recurrences N of patients : 93; age 65±2 yrs Underlying Heart Disease: Hypertension 53%; valvular 15%; IHD 9%; CHF 9%; no structural HD 21% A. Fib duration: 11±2 months LA diameter: 47±1 mm; EF:55±2% All patients were on anticoagulant and amiodarone (96%) therapy for at least 4 weeks LF/HF ratio % of recurrence of atrial 0 fibrillation All after SR cardioversion A.Fib LF/HF ³ Six month recurrence rate: 38% 20 0 JACC 2001 LF/HF < days 1 month 3 months 6 months

29 JCM, 2008

30 JCM, 2008