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Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy
Insights
Physiologic left ventricular hypertrophy in athletes shows normal diastolic function. Abnormalities in heart disease stem from factors beyond hypertrophy itself, not the thickening alone.
Area of Science:
- Cardiology
- Exercise Physiology
- Cardiac Imaging
Background:
- Left ventricular hypertrophy (LVH) from conditions like aortic stenosis and hypertension is linked to impaired diastolic function.
- It remains unclear if these diastolic abnormalities are intrinsic to hypertrophy or caused by other pathological factors.
Purpose of the Study:
- To determine if diastolic dysfunction in pathological hypertrophy is an inherent consequence of cardiac muscle thickening or due to additional disease-related factors.
- To compare left ventricular early diastolic function between highly trained athletes and healthy controls.
Main Methods:
- Echocardiography was used to assess left ventricular early diastolic function in athletes and age-matched controls.
- Athletes were divided into swimmers (normal wall thickness to dimension ratio) and power lifters (increased ratio).
- Diastolic function indexes were analyzed, considering ventricular size and systolic performance.
Main Results:
- Athletes exhibited increased peak rates of left ventricular dimension increase and wall thinning compared to controls, despite higher LV mass.
- These enhanced diastolic indexes in athletes correlated with larger ventricular size and better systolic function.
- After adjusting for ventricular size and systolic function, differences in diastolic function between athletes and controls disappeared.
Conclusions:
- Physiological left ventricular hypertrophy in athletes is associated with normal diastolic function when accounting for ventricular size and systolic performance.
- Abnormalities in diastolic function observed in pathological hypertrophy likely result from factors beyond the hypertrophy itself.
- This suggests that diastolic dysfunction in conditions like aortic stenosis and hypertension is not solely due to the thickened heart muscle.
Abstract:
Left ventricular hypertrophy due to aortic stenosis, hypertension and other forms of heart disease is associated with abnormalities of diastolic function. It is uncertain whether these changes are an inherent consequence of the hypertrophic process or represent additional pathologic factors. To investigate this issue, echocardiographic indexes of left ventricular early diastolic function in highly trained athletes were compared with those in age-matched normal control subjects. Athletes were equally classified into two groups: 11 swimmers who had a pattern of myocardial hypertrophy with normal wall thickness to dimension ratio and 11 power lifters whose wall thickness to dimension ratio was increased. The peak rates of left ventricular dimension increase and wall thinning in swimmers and power lifters were greater than in control subjects despite significantly higher left ventricular wall thickness and left ventricular mass index in the athletes. This increase in diastolic function indexes was associated with greater ventricular size and systolic performance. Normalization of the peak rate of dimension increase for end-diastolic dimension and adjustment of the peak rate of wall thinning for the fractional systolic thickening resolved any differences between groups. Thus, after the effects of ventricular size and systolic function were taken into consideration, diastolic function was normal in these subjects with considerable physiologic hypertrophy. This is in contrast to the findings in patients with hypertrophy associated with left ventricular pressure or volume overload, and suggests that abnormalities of diastolic function seen in pathologic hypertrophy are due to factors other than cardiac hypertrophy itself.