CORRESPONDENCE: LETTER TO THE EDITOR
Detection of Pathologic or Physiologic Left Ventricular Remodeling in Athletes
Eric Abergel, MD, PhD* and
Albert A. Hagege, MD, PhD
* Service de Cardiologie, Hôpital Européen Georges, Pompidou, 20 rue Leblanc, 75908 Paris Cédex 15, France (Email: eric.abergel{at}egp.ap-hop-paris.fr).
In a recent issue of the Journal, Whalley et al. (1) analyzed echocardiographic left ventricular (LV) modifications due to training in a small cohort of endurance male athletes as compared to an untrained control group. They found that body fat-free mass (FFM)—as measured by dual-photon X-ray absorptiometry—was the only independent predictor of both left ventricular mass (LVM) and diastolic diameter (LVDD) in athletes, suggesting that LV remodeling could reflect a normal physiologic response to training-induced increased FFM.
Interestingly, although FFM is technically difficult to assess in current clinical practice, Whalley et al. (1) also noted that, by indexing LVM and LVDD to height2.7, there was no longer any difference between athletes and controls, suggesting that this simple approach might be relevant to eliminate pathologic LV hypertrophy in endurance athletes.
We recently reported echocardiographic characteristics of a large cohort of 286 professional cyclists (2), a sport that combines endurance and resistance training and where performance-enhancing drugs are frequently used (3). In these very highly trained athletes, LV remodeling was markedly more important than in the study by Whalley et al. (1) (60.1 ± 3.9 vs. 55.6 ± 0.62 mm for LVDD and 141 ± 21 vs. 94 ± 3 g/m2 for LVM/body surface area [BSA], respectively). As in the Whalley study, differences with an untrained control group (n = 52) persisted despite indexation to BSA. However, as opposed to the Whalley et al. (1) study, indexation to height2.7 was not efficient to abolish differences between athletes and controls, neither for LVD/height2.7 (12.6 ± 1.1 vs. 10.6 ± 1.2 mm/m2.7, respectively, p < 0.0001), nor for LVM/height2.7 (55.7 ± 8.7 vs. 29.5 ± 4.8 mm/m2.7, respectively, p < 0.0001; E. Abergel, unpublished data, 2004).
Thus, the conclusions by Whalley et al. (1) might not apply to nonendurance and/or very highly trained athletes. These conflicting results might also suggest that LV remodeling partially reflects a pharmacological intervention and that height2,7 indexation could be a simple screening test to suspect drug abuse in high-level endurance athletes.
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References
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1. Whalley GA, Doughty RN, Gamble GD, et al. Association of fat-free mass and training status with left ventricular size and mass in endurance-trained athletes J Am Coll Cardiol 2004;44:892-896.[Abstract/Free Full Text]
2. Abergel E, Chatellier G, Hagege AA, et al. Serial left ventricular adaptations in world-class professional cyclistsimplications for disease screening and follow-up. J Am Coll Cardiol 2004;44:144-149.[Abstract/Free Full Text]
3. Noakes TD. Tainted glory—doping and athletic performance N Engl J Med 2004;351:847-849.[Free Full Text]
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