CLINICAL RESEARCH: EXERCISE, DIET, AND THE HEART
Serial left ventricular adaptations in world-class professional cyclists
Implications for disease screening and follow-up
Eric Abergel, MD*,*,
Gilles Chatellier, MD ,
Albert A. Hagege, MD, PhD*,
Agnes Oblak, MD*,
Ales Linhart, MD*,
Alain Ducardonnet, MD and
Joël Menard, MD, PhD
* Service de Cardiologie, Paris, France
Unité d'Épidémiologie et de Recherche Clinique, Paris, France
Centre d'Investigations Cliniques, Hôpital Européen Georges Pompidou, Paris, France
Institut C ur Effort Santé, Paris, France
Manuscript received November 18, 2003;
revised manuscript received January 24, 2004,
accepted February 17, 2004.
* Address for correspondence: Dr. Eric Abergel, Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris Cédex 15, France.
eric.abergel{at}egp.ap-hop-paris.fr
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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Abbreviations and Acronyms
| | BSA | = body surface area | | DCM | = dilated cardiomyopathy | | eFS | = endocardial fractional shortening | | ESS | = meridional end-systolic stress | | HCM | = hypertrophic cardiomyopathy | | LV | = left ventricle/ventricular | | LVEF | = left ventricular ejection fraction | | LVH | = left ventricular hypertrophy | | LVIDd | = left ventricular internal diameter at end-diastole | | LVIDs | = left ventricular internal diameters at end-systole | | mFS | = midwall fractional shortening | | WT | = wall thickness |
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