February 26, 2002
View Full PaperRemodeling of Left Ventricular Hypertrophy in Elite Athletes After Long-Term Deconditioning
Structured PICO
Does long-term deconditioning reverse left ventricular hypertrophy and cavity enlargement in elite athletes?
P
Population
40 elite male athletes with marked LV cavity enlargement (≥60 mm), wall thickness (≥13 mm), or both, mean age 24 ± 4 years at peak training.
I
Intervention
Long-term deconditioning (detraining) for 1 to 13 years (mean 5.6 ± 3.8 years).
C
Comparator
Baseline measurements at peak training.
O
Outcome
Changes in LV cavity dimension, maximum wall thickness, and LV mass normalized to height measured by serial echocardiograms.surrogate
Long-term deconditioning in elite athletes leads to significant but often incomplete reversal of left ventricular cavity enlargement, while wall thickness normalizes completely.
Abstract
BACKGROUND: The clinical significance and long-term consequences of left ventricular (LV) hypertrophy associated with intensive athletic conditioning remain unresolved. METHODS AND RESULTS: We prospectively evaluated 40 elite male athletes who had shown marked LV cavity enlargement of > or = 60 mm, wall thickness of > or = 13 mm, or both in a longitudinal fashion with serial echocardiograms, initially at peak training (age 24 +/- 4 years) and subsequently after a long-term deconditioning period (1 to 13 years; mean, 5.6 +/- 3.8). After detraining, LV cavity dimension decreased by 7% (61.2 +/- 2.9 to 57.2 +/- 3.1 mm; P or = 60 mm) in 9 athletes (22%); in contrast, wall thickness returned to normal in each athlete. Multiple regression analysis demonstrated that approximately 50% of the incomplete reduction in cavity dimension was explained by increased body weight and recreational physical activity performed during the follow-up period. No athlete had developed cardiac symptoms, impaired exercise performance, or evidence of LV dysfunction. CONCLUSIONS: LV remodeling was evident after long-term detraining, with significant reduction in cavity size and normalization of wall thickness. Resolution of cavity enlargement was, however, incomplete in most cases, and substantial chamber dilatation persisted in >20% of athletes. The possibility that this residual LV hypertrophy, apparently part of the athlete's heart syndrome, may have future long-term clinical implications in some individuals cannot be excluded with certainty.