Vascular and cardiac remodeling in world class professional cyclists

doi:10.1016/S0002-8703(98)70126-7

American Heart Journal

Volume 136, Issue 5, November 1998, Pages 818-823

https://doi.org/10.1016/S0002-8703(98)70126-7 Get rights and content

Abstract

Background Numerous studies have demonstrated that left ventricular (LV) hypertrophy is often associated with conditioning. Methods and Results The aim of the study was to evaluate cardiac and carotid artery changes induced by professional cycling. We collected M-mode left ventricle and B-mode right common carotid artery data from 149 male professional cyclists before the 1995 “Tour de France” race and 52 male control subjects. LV mass indexed to body surface area in cyclists was double that in control subjects, with no overlap of 95% confidence intervals (cyclists 100.9 to 187 g/m² and control subjects 51.8 to 96.3 g/m² ). Both mean arterial diameter and mean arterial diastolic intima-media thickness (IMT) were 13% higher in cyclists than in control subjects, with overlap of 95% confidence intervals (for arterial IMT 0.45 to 0.65 mm in cyclists and 0.38 to 0.60 mm in control subjects). Conclusions Our results suggest that intense cycling has an effect on the cardiovascular system, more pronounced on the left ventricle and less pronounced on large arteries. Nevertheless, athletic training should be considered as a potential determinant of carotid modification. (Am Heart J 1998;136:818-23.)

Section snippets

Study population

This study was a field study: All athletes were studied before the beginning of the “Tour de France” race in July 1995. All 198 professional male cyclists participating in the race (22 teams, 9 athletes per team) agreed to participate in the study. However, because each team could only spend approximately 45 minutes in the echocardiography laboratory, we could evaluate only 149 (75.3%) athletes. A control group of 52 young male physicians working at the Broussais hospital, matched for body

Subject characteristics

Relevant characteristics of the subjects are summarized in Table I.

. Comparison of general characteristics of professional cyclists and control subjects

Empty Cell	Cyclists	Control subjects	P value
No. of subjects	149	52
Age (y)	28.1 ± 3.2	26.3 ± 4.0	.002
Weight (kg)	71.6 ± 6.5	71.0 ± 8.8	.57
Height (cm)	178 ± 6	177 ± 6	.1
Body surface area (m² )	1.89 ± 0.12	1.87 ± 0.14	.28
Systolic blood pressure (mm Hg)	120 ± 9	126 ± 13	.0006
Diastolic blood pressure (mm Hg)	66 ± 8	77 ± 10	<.0001
Heart rate (beats/min)	52 ± 8	71 ± 13	<.0001

Values are

Discussion

Intense training modifies cardiovascular geometry. In this report comparing world class cyclists with normal subjects, we confirm that intense training increases LV mass, and we show that vascular geometry is also modified, although to a lesser extent.

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Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis
2020, Progress in Cardiovascular Diseases
To compare heart structure and function in endurance athletes relative to participants of other sports and non-athletic controls in units relative to body size. A secondary objective was to assess the association between endurance cycling and cardiac abnormalities.
Five electronic databases (CINAHL, Cochrane Library, Medline, Scopus, and SPORTdiscus) were searched from the earliest record to 14 December 2019 to identify studies investigating cardiovascular structure and function in cyclists. Of the 4865 unique articles identified, 70 met inclusion criteria and of these, 22 articles presented 10 cardiovascular parameters in units relative to body size for meta-analysis and five presented data relating to incidence of cardiac abnormalities. Qualitative analysis was performed on remaining data. The overall quality of evidence was assessed using GRADE. Odds ratios were calculated to compare the incidence of cardiac abnormality.
Heart structure was significantly larger in cyclists compared to non-athletic controls for left ventricular: mass; end-diastolic volume, interventricular septal diameter and internal diameter; posterior wall thickness, and end-systolic internal diameter. Compared to high static and high dynamic sports (e.g., kayaking and canoeing), low-to-moderate static and moderate-to-high dynamic sports (e.g., running and swimming) and moderate-to-high static and low-to-moderate dynamic sports (e.g., bodybuilding and wrestling), endurance cyclists end-diastolic left ventricular internal diameter was consistently larger (mean difference 1.2–3.2 mm/m²). Cardiac abnormalities were higher in cyclists compared to controls (odds ratio: 1.5, 95%CI 1.2–1.8), but the types of cardiac abnormalities in cyclists were not different to other athletes.
Endurance cycling is associated with a larger heart relative to body size and an increased incidence of cardiac abnormalities relative to controls.
Influence of exercise training mode on arterial diameter: A systematic review and meta-analysis
2016, Journal of Science and Medicine in Sport
Citation Excerpt :
Chronic vascular remodelling, including changes in arterial wall thickness,1 diameter2 and wall-to-lumen ratio,3 in response to exercise training has been widely debated. Whilst the majority of research supports differences in arterial diameter in athletes compared to sedentary or recreationally active controls,1–9 it remains unclear whether the mode of exercise training (endurance, resistance or mixed) plays a role in these differences. This may be due, in part, to the examination of different arteries and the wide range of sports studied.
To examine whether differences in arterial diameter exist between athletes participating in endurance, resistance or mixed exercise training.
A systematic review with meta-analysis.
Random effects meta-analyses of the weighted mean difference in aortic, carotid, brachial and femoral arterial diameters, height and body mass were conducted on data from 16 peer-reviewed studies indexed on PubMed, MEDLINE, SCOPUS and Sport Discus. Effect sizes were calculated as the standardised difference in means (δ), and used to compare endurance (n = 163), resistance (n = 192), and mixed trained athletes (n = 360), with controls (n = 440).
Compared to controls, endurance athletes displayed the greatest difference in diameter in the brachial artery (δ = 1.84, 95% CI: 0.59, 3.09, p < 0.01), whereas for mixed athletes, the greatest difference in diameter occurred in the femoral artery (δ = 3.65, 95% CI: 2.21, 5.10, p < 0.01), despite there being no differences in height or body mass between these groups. Resistance athletes had a significantly greater body mass (p = 0.047) and aortic diameter (δ = 1.81, 95% CI: 1.58, 2.05, p < 0.01) than controls, however differences in other vessels could not be determined through meta-analysis due to insufficient data.
Our results provide evidence for localised arterial differences, which occur more extensively in peripheral vessels (brachial and femoral). Chronically, vascular remodelling may occur as a result of the specific haemodynamic conditions within each vessel, which likely differs depending on the mode of exercise. In the future, empirical research is needed to understand the effect of resistance training on chronic vascular remodelling, as this is not well documented.
Cardiac magnetic resonance assessment of left and right ventricular morphologic and functional adaptations in professional soccer players
2010, American Heart Journal
Citation Excerpt :
The balanced increase in LVEDV (21.6%) and RVEDV (21.3%) found in our study contrasts with CMRI investigations in triathletes performed by Petersen et al,10 showing an unbalanced biventricular hypertrophy, favoring the LV, and agrees with results from Scharhag et al.23 Cardiac magnetic resonance imaging studies investigating athletes undergoing sustained power or anaerobic power training (eg, sprinters) suggest that the effect of exercise training on the RV chamber size may be more pronounced than the effect on the LV chamber size.30 In contrast to echocardiographic studies in endurance athletes (144 ± 22.0 g/m2)31 and soccer players (132.4 ± 23.7 g/m2),32 none of the soccer players in our investigation (81.0 ± 8.6 g/m2) had a LVMM above the clinical limit at CMRI (113 g/m2). Partly, the wide discrepancy in LVMM is probably due to different methods of image analysis (inclusion or exclusion of papillary muscles) and the technical difficulty in analyzing ventricular volume and mass with echocardiography.
Professional, long-term physical training is associated with cardiac morphologic and functional changes that depend on the type of exercise performed. So far, the specific effect of soccer training on cardiac morphology has not been investigated with cardiac magnetic resonance imaging (CMRI). We sought to use CMRI to study left ventricular (LV) and right ventricular (RV) morphologic and functional adaptations in professional soccer players.
Twenty-nine male professional soccer players (mean age 24.6 ± 3.9 years, range 18–31 years) in different playing positions and 29 nonathlete male controls (27.0 ± 3.7 years, 21–34 years) underwent CMRI. Electrocardiographic-gated steady-state free-precession cine CMRI was used to measure myocardial mass (MM), end-diastolic volume (EDV) and end-systolic volume, stroke volume (SV), ejection fraction, and cardiac index at rest. We calculated the ventricular remodeling index (RI) to describe the pattern of cardiac hypertrophy.
Ventricular volume and mass indices were significantly (P < .001) higher in athletes. LVEDV and RVEDV on MRI was above normal in 27/29 athletes. There was a strong positive correlation between EDV and myocardial mass (P < .01). The LVRI and RVRI were similar (0.73 ± 0.1 g/mL; 0.22 ± 0.01 g/mL) to that of controls (0.71 ± 0.1 g/mL; 0.22 ± 0.01 g/mL). No significant differences were observed for LV ejection fraction and cardiac index. Neither the comparison of athletes in different playing positions nor the comparison of younger and older players revealed statistically significant differences.
Cardiac magnetic resonance imaging measurements enable studying the mechanisms of LV and RV adaptation in professional soccer players and reflect the ventricular response to combined endurance and strength based training.
The effects of endurance and recreational exercise on subclinical evidence of atherosclerosis in young adults
2010, American Journal of the Medical Sciences
Citation Excerpt :
The literature provides contradictory data on this topic. Some studies show that physical activity does reduce the maximal and average carotid IMT values by 14% to 45%, whereas other published data fails to provide such evidence.13–15,17,18 In summary, it is very likely that physical activity has an influence on the IMT, although no subanalysis of the value and impact of exercise type was performed in the above-mentioned studies.
This study set out to identify the effects of recreational and endurance exercise on subclinical evidence of atherosclerosis in young adults.
Cardiovascular disease risk factors and intima-media thickness determination by B-mode ultrasonography of 150 subjects were correlated to endurance exercise, recreational exercise, and sedentary lifestyle. The subjects comprised 20- to 40- year-old men and women without cardiovascular disease. This crosssectional, case-control study analyzed data on the laboratory parameters and information collected from a risk factor questionnaire.
The athletes, both endurance and recreational groups, have significantly superior values with respect to physiognomy, lipid profile, and inflammatory markers in relation to the nonexercising study population (all P < 0.05). Detailed analysis showed markedly reduced values for relative body fat (relative reduction 14.3%), low-density lipoprotein (10.6%), and triglycerides (13.5%) and a 50% reduction of hs-C-reactive protein. In the univariate and multivariate comparison of athletic (n = 100) and nonathletic (n = 50) groups, exercise did not show to exert a significant influence on vascular wall parameters (for all, P > 0.05).
Exercise, in recreational and endurance form, between the ages of 20 and 40 years exerts a preventive influence on cardiovascular risk factors but seems to fail to affect early, atherosclerotic vascular wall changes.
Echocardiographic characteristics of professional tennis players at the Roland Garros French open
2007, American Heart Journal
Citation Excerpt :
We also found that atrial dilation is related to playing style because it was significant in baseline players but not in offensive players. Left ventricular hypertrophy is the most common change induced by intensive sport.1,2,4 However, the limit between physiological and pathologic hypertrophy may sometimes be difficult to distinguish.20
Intensive sport may induce cardiac modifications. No recent study has been performed in elite tennis players. The aim of this cross-sectional study was to analyze the cardiac characteristics in a population of professional tennis players.
During the 2004 French Open Tennis Tournament, we offered complete echocardiographic screening to all professional tennis players. The study population consisted of 160 subjects: 80 tennis players (50 men and 30 women) and age- and sex-matched control groups (n = 80).
Indexed left ventricular mass was significantly higher in tennis players (P < .0001). Left ventricular hypertrophy was present in 18 male (36%) and 6 female (20%) tennis players versus 2 men (4%) and no woman in the control groups (P < .0001 and P = .02, respectively). All indexed right and left atrial measurements were significantly higher in tennis players (P < .003). The incidence of left and right atrial dilation was significantly higher in tennis players (P ≤ .0001). Indexed right atrial area and left atrial volume were significantly higher in baseline players as compared with offensive players and to control groups (P < .0001), whereas there was no significant difference in left ventricular mass according to the style of play (P > .75). No significant between-group difference was observed in Doppler data.
In the present study, professional tennis players presented significant cardiac differences, as compared to a control group, with moderate left ventricular hypertrophy, bilateral atrial dilation, and normal systolic and diastolic functions. Atrial dilation is related to the style of play (baseline or offensive) and should be considered as physiological in tennis players.
Serial left ventricular adaptations in world-class professional cyclists: Implications for disease screening and follow-up
2004, Journal of the American College of Cardiology
The purpose of this research was to study long-term left ventricular (LV) adaptations in very-high-level endurance athletes.
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.
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).
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.
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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^☆: From Centre de Médecine Préventive Cardio-vasculaire, Service d’Informatique Médicale, Institut Cœur Effort Santé, Service de cardiologie, Hôpital Broussais.

^☆☆: Reprint requests: Eric Abergel, MD, Centre de Médecine Préventive Cardio-vasculaire (Med 9), Hôpital Broussais, 96 rue Didot 75674 Paris CEDEX 14, France.

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Vascular and cardiac remodeling in world class professional cyclists☆,☆☆,★

Abstract

Section snippets

Study population

Subject characteristics

Discussion

Am J Cardiol

Atherosclerosis

Am J Hypertens

Atherosclerosis

J Am Coll Cardiol

The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes

N Engl J Med

Effect of static and dynamic exercise on heart volume, contractility, and left ventricular dimensions

Circ Res

Cardiac structure and function in cyclists and runners

Br Heart J

Non-invasive evaluation of cardiac function in professional cyclists