Why the study?
Knowledge of long-term left ventricular adaptations in very-high-level endurance athletes is necessary to distinguish physiological changes from cardiomyopathies such as hypertrophic or dilated cardiomyopathy.
Cross-Sectional (n=186)
Elite endurance cycling is associated with significantly greater structural remodeling of the right heart compared to sprint cycling, with male athletes exhibiting more pronounced dimensional adaptations than females.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Recurrent subtle injury might lead to alterations of systolic or diastolic function, as has been suggested in cyclists who have competed in multiple Tour de France races or older marathon runners competing in multiple marathons.”
“Our results demonstrate that exercise conditioning is not responsible itself for left ventricular dysfunction or abnormal cardiac morphologic changes in long-term Olympic athletes and confirms the benign nature of physiologic athlete's heart, even under extreme conditions over extended periods of time. Therefore, left ventricular dysfunction in trained athletes should raise the clinical suspicion of an underlying pathologic condition.”
“A prominent concern is the use of performance-enhancing drugs, including but not limited to anabolic steroids, growth hormones, erythropoietin, and stimulants—which are notoriously prevalent in the cycling world and whose long-term cardiac effects are incompletely studied. The impact of such substances upon the findings of Abergel et al. cannot be known, but they may have contributed to the more extreme findings than previously reported. Furthermore, increased use over time may have been responsible for the more marked changes in the 1998 cohort.”
Endurance and male sex were associated with larger RV dimensions in cyclists; supports sport- and sex-specific norms but remains hypothesis-generating for outcomes.
OBJECTIVES: The purpose of this research was to study long-term left ventricular (LV) adaptations in very-high-level endurance athletes. BACKGROUND: Knowledge of cardiac changes in athletes, who are at particularly high risk of sudden cardiac death, is mandatory to detect hypertrophic cardiomyopathy (HCM) or dilated (DCM) cardiomyopathy. METHODS: We carried out echocardiographic examinations on 286 cyclists (group A) and 52 matched sedentary volunteers (group C); 148 cyclists participated in the 1995 "Tour de France" race (group A1), 138 in the 1998 race (group A2), and 37 in both (group B). RESULTS: In groups A, A1, A2, and C, respectively, diastolic left ventricular diameter (LVID) was 60.1 +/- 3.9 mm, 59.2 +/- 3.8 mm, 61.0 +/- 3.9 mm, and 49.0 +/- 4.3 mm (A vs. C and A1 vs. A2, p < 0.0001), and maximal wall thickness (WT) was 11.1 +/- 1.3 mm, 11.6 +/- 1.3 mm, 10.6 +/- 1.1 mm, and 8.6 +/- 1.0 mm (A vs. C and A1 vs. A2, p < 0.0001). Among group A, 147 (51.4%) had LVID >60 mm; 17 of them had also a below normal (<52%) left ventricular ejection fraction (LVEF). Wall thickness exceeded 13 mm in 25 athletes (8.7%) (always <15 mm), 23 with LVID >55 mm. In group B, LVID increased (58.3 +/- 4.8 mm to 60.3 +/- 4.2 mm, p < 0.001) and WT decreased (11.8 +/- 1.2 mm to 10.8 +/- 1.2 mm, p < 0.001) with time. CONCLUSIONS: Over one-half of these athletes exhibited unusual LV dilation, along with a reduced LVEF in 11.6% (17 of 147), compatible with the diagnosis of DCM. Increased WT was less common (always <15 mm) and scarce without LV dilation (<1%), eliminating the diagnosis of HCM. Serial examinations showed evidence of further LV dilation along with wall thinning. These results might have important implications for screening in athletes.
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Abergel et al. (2004) conducted a cross-sectional in Elite international-level cyclists (endurance and sprint) (n=186). Endurance cycling vs. Sprint cycling was evaluated on Right ventricular end-diastolic area (RVEDA) index (Mean difference 1.96 cm2/m2, 95% CI 1.28-2.63, p=<0.0001).
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