What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiac remodeling (n=105). Intervention: High intensity sports vs. Moderate-low intensity sports. Primary outcome: Changes in left ventricular geometry (OR 2.91, 95% CI 1.03-8.23, p=0.044).

June 21, 2021Open Access

Cardiac remodeling induced by exercise in male master athletes

HDHélder DoresHospital da Luz PGPedro de Araújo GonçalvesHospital da Luz JMJosé MongeHospital da Luz

Key Result

High intensity sports participation was an independent predictor of changes in left ventricular geometry in male master athletes (OR 2.91).

Study Design

Type

Cross-Sectional (n=105)

Structured PICO

Does regular exercise training induce cardiac remodeling in male master athletes?

Population

105 male master athletes aged 40 years and older, participating in regular exercise for at least 4 hours/week for a minimum of 5 years, evaluated for cardiac remodeling.

Exposure

Regular exercise training (mostly endurance sports, median training-volume 66 METs/h/week)

Outcome

Cardiac remodeling evaluated by transthoracic echocardiography (changes in left ventricular geometry, left ventricular dilation, right ventricular remodeling, left atrium dilation, right atrium dilation)surrogate

Cardiac structural adaptations, including changes in LV geometry and chamber dilation, are frequent in male master athletes and correlate significantly with the intensity and volume of endurance exercise.

Main Result

Odds Ratio: 2.91 (95% CI 1.03–8.23)

Absolute Event Rate: 70% vs 43.5%

p-value: p=0.044

Limitations

Data do not apply to women
May not be representative of all sports modalities due to potential recruitment bias
Sample size may be underpowered
Cross-sectional design limits causal inference
Past performance enhancing substances abuse was difficult to collect
Absence of a non-athlete control group

Abstract

Abstract Aims: To describe cardiac remodeling in a population of male master athletes evaluated by transthoracic echocardiography and to analyse its relationship with several exercise-related characteristics. Methods and results: A total of 105 male master athletes aged ≥40 years old, mostly involved in endurance sports (81.0%) with a median training-volume of 66 44; 103 METs/h/week, were studied. Left ventricular end-diastolic and end-systolic volumes were above the references in 84.8% and 75.8% athletes, decreasing in frequency when adjusted for BSA (26.3% and 23.2%). LV geometry was changed in more than half of the athletes (eccentric hypertrophy 28.3%, concentric remodelling 15.2% and concentric hypertrophy 8.1%) and several right ventricular (RV) dimensions were increased. Left atrium was dilated in 53.5% and right atrium in 37.4% athletes; only one athlete had a dilated aorta. Mean LV ejection fraction was 61±7% and global longitudinal strain -18.3±2.0%. Changes in LV geometry were more common in high intensity sports; LV dilation in athletes exercising >10 hours/week and in high intensity sports; RV dilation in athletes exercising >66 MET-hour/week and in endurance sports. In multivariate analysis high intensity sports remained an independent predictor of changes in LV geometry. There was a significant correlation between volume of exercise and cardiac structural adaptations. Conclusions: Cardiac structural adaptations were frequent in male master athletes, more pronounced in those involved in endurance sports, with high intensity and high volume of exercise. This data reinforces the concept that the characteristics of exercise are major determinants of cardiac remodeling and should be considered during athletes’ evaluation.

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