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
Hippocrates 460-370 B.C. Eating alone will not keep a man well; he must also take exercise. For food and exercise work together to produce health
PHYSICAL ACTIVITY IS BENEFICIAL FOR CARDIAC HEALTH
Gielen S et al. Circulation 2010; 122:1221-1238
EXERCISE INCREASES AEROBIC CAPACITY Q = SV x HR VO2 MAX=Q χ A-V O2
Deligiannis et al,science and Health,42,2002
IMPROVEMENT OF AEROBIC CAPACITY IN CAD PATIENTS BY 1 ΜΕΤ CAUSES 10% REDUCTION OF MORTALITY. Franklin: J Cardiovasc Nurs 2003; 18(2): 116 123
Lab. Aristotle University of of Thessaloniki
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-
Effects of athletic training on heart rate variability ATHLETE SEDENTARY Kouidi E. et al, Clin Physiol Funct Imag 2002
EFFECTS OF EXERCISE TRAINING ON BAROREFLEX SENSITIVITY BRS (ms/mmhg) BEI (%) Petraki M et al Clin Nephrol 2008
TRAINING AND LIPIDS PROFILE Nutrition, Μetabolism & Cardiovascular Diseases 2006;16:543-549
Primary Prevention Preventing a target condition, such as heart disease General health promotion efforts
ARE SPORTS BENEFICIAL OR DANGEROUS FOR THE CARDIAC HEALTH? Sudden Cardiac Death of Pheidippides
ATHLETE S HEART OR ATHLETIC HEART SYNDROME
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)
Έκκεντρη Συγκεντρική Mihl C, et al Neth Heart J 2008;16:129-33
THE MAJOR SIGNALING PATHWAYS INVOLVED IN CARDIAC HYPERTROPHY Bernardo B, et al. Pharmacology & Therapeutics 2010; 128: 191-227
DYNAMIC EXERCISE AND CARDIAC CHAMBERS DILATATION Nottin S, et al J Physiol 2008; 586: 4721-33
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
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
Dancing with the Doping to Cardiac Death!!! A.Deligiannis, Lisbon, 2014
. 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;114:1633-1644
Naylor LH et al. Sports Med 2008; 38 (1): 69-90
. Distribution of cardiac dimensions in large populations of highly trained male and female athletes. Maron B J, and Pelliccia A Circulation. 2006;114:1633-1644
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
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
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
The dilemma remains
10 REASONS WHY AN ATHLETE S HEART IS USUALLY NOT DANGEROUS
1. ATHLETE S WITH LARGE HEARTS TEND TO HAVE EXCELLENT CARDIAC FUNCTION
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
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
Hoogsteen J et al. Int J Cardiovasc Imaging 2004 ; 20(1):19-26.
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
From: Athlete's Heart: The Potential for Multimodality Imaging to Address the Critical Remaining Questions J Am Coll Cardiol Img. 2009;2(3):350-363. doi:10.1016/j.jcmg.2008.12.011 y.
2. ATHLETE S HEART IS NOT ENTIRELY PERMANENT
. Cardiac remodeling caused by long-term deconditioning. Maron B J, and Pelliccia A Circulation. 2006;114:1633-1644
3. ATHLETE S HEARTS ARE SYMMETRICAL AND UNIFORM
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, 1856-1863 http://dx.doi.org/10.1016/s0735-1097(02)02478-6
Luthi P, et al. Eur J Echocardiogr 2008; 9(2):261-7.
. The relative impact of different sports disciplines on aortic dimension. Pelliccia A et al. Circulation. 2010;122:698-706
. 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-
4. ATHLETE S HEARTS ARE WELL VASCULARIZED
EXERCISE AND ARTERIES REMODELING Brown MD, Exp Physiol 2003; 88: 645-865
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;27:1571-1578
ARTERIAL COMPLIANCE AND β-stiffness INDEX Circulation 2000; 102: 1270-
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
5. CORONARY ARTERIES ARE GENERALLY LARGER IN ATHLETES
Green D et al. Exp Physiol 2012; 97: 295 304
CORONARY ARTERIES IN ATHLETES
6. ATHLETE S HEART IS NOT CUMULATIVE
7. ATHLETE S WITH BIG HEARTS ARE USUALLY ASYMPTOMATIC
8. ATHLETE S HEARTS USUALLY HAVE HEALTHY MITOCHONDRIA Kouidi E.,Sports Med, 32, 1997
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
9. ATHLETE S HEART IS LARGELY CAUSED BY DIFFERENT GENES AND SIGNALING PATHWAYS THAN HEART DISEASE
. 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;114:1633-1644
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
10. ELITE ATHLETES LIVE A LONG TIME
Age-adjusted mortality rates in healthy men categorized by level of fitness. Myers J Circulation. 2003;107:e2-e5
BENEFITS AND RISKS OF EXERCISE
TOO MUCH EXERCISE CAN BE BAD FOR THE HEART!
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