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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 Cur 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.

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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