Comparison of left and right ventricular adaptation in endurance-trained male athletes.

Characteristics of the athlete's heart have been investigated mostly in the left ventricle (LV); reports referring to the right ventricle (RV) have only appeared recently. The aim of the present study was to compare the training effects on RV and LV in elite male endurance athletes. To this end, echocardiography was conducted in 52 elite endurance athletes (A) and in 25 non-athletes (NA). Differences between A and NA in the morphology was more marked in the RV (body-size-matched (rel.)) long axis diastolic diameter (RVLADd): 63.4 ± 6.3 vs. 56.4 ± 6.3; rel. short axis diastolic diameter (RVSADd): 27.3 ± 3.6 vs. 23.6 ± 2.7 mm/m, RV diastolic area 28 ± 5.0 vs. 21.3 ± 4.3 cm2 in all cases, p < 0.001) than in the LV (rel. LVLADd: 63.8 mm/m ± 5.6 vs. 60.7 mm/m ± 6.6, p < 0.05, rel.LVSADd 37.8 ± 3.1 vs. 35.3 ± 2.4, no difference). In the athletes ratios of peak early to late diastolic filling velocity (2.07 ± 0.51 vs. 1.75 ± 0.36, p < 0.01), the TDI-determined E'/A' ratio in the septal (1.89 ± 0.55 vs. 1.62 ± 0.55, p < 0.05) and lateral (2.62 ± 0.72, vs. 2.18 ± 0.87, p < 0.001) walls were significantly higher than in NA only in the LV. Results indicate that in male endurance athletes morphologic adaptation is similar or slightly stronger in the RV than in the LV, functional adaptation seems to be stronger in the LV.

Echocardiographic characteristics in adolescent junior male athletes of different sport events.

The purpose of this study was to examine the effects of different sport activities on cardiac adaptation. Echocardiographic data of 137 athletes and 21 non-athletes were measured and compared in two age groups 15-16 and 17-18 years of age. Athletes belonged into three groups according to their sports activity (endurance events, power athletes, ball game players). The observed variables were related to body size by indices in which the exponents of the numerator and the denominator were matched. Left ventricular hypertrophy was manifest in all athletic groups. Power athletes had the largest mean left ventricular wall thickness (LVWTd) in both age groups. In the older age group differences between the athletic groups were smaller, but the endurance and power athletes had significantly higher wall thickness. Left ventricular internal diameter (LVIDd) was the largest in the endurance athletes, while mean relative muscle mass (LVMM) was the largest in the power athletes. LVMM of the older endurance athletes was significantly larger. Muscular quotient (MQ) was the highest in the endurance athletes; in the 17-18-year group there was no inter-event difference. Bradycardia was most manifest in the endurance athletes and ball game players, power athletes had higher resting heart rates than non-athletic subjects. It can be inferred that endurance training induces firstly an enlargement of the left ventricle what is then followed by an increase of muscle mass. In the studied functional and regulatory parameters no difference was found between the athletic and non-athletic groups.

Cardiac hypertrophy and diastolic function in physically well trained and in obese men.

OBJECTIVE: The aim of the present study was to compare cardiac hypertrophy and diastolic function in extremely obese male patients and physically active adult male subjects of similar age (means 43.0-43.4 y). DESIGN: Data of male patients referred to our hospital ward in order to reduce their body weight (BW) were compared with those of physically active and nonactive healthy males. SUBJECTS: The groups contained 21-24 male subjects, very active and moderately active subjects taking part in regular competitive or leisure time physical activity were in the two athletic groups, severely overweight patients constituted the obese group and healthy persons served as controls. MEASUREMENTS: Two-dimensionally guided M-mode and Doppler recordings. RESULTS: In comparison with the controls, obese patients had larger left atrial systolic and left ventricular (LV) diastolic internal diameters, LV diastolic wall thickness and muscle mass. Of the body size-related indices, only the left atrial systolic diameter index was significantly higher. LV systolic and diastolic functions were impaired as indicated by a decreased ejection fraction (EF), higher heart rate (HR), decreased E/A quotient and increased isovolumetric relaxation time. In the physically very active subjects, a thicker LV diastolic wall was seen without LV dilatation. Body size-related wall thickness and muscle mass were significantly higher than in the controls. EF and HR did not differ from those of the controls. CONCLUSION: The most useful help to distinguish between physiological and pathological left ventricular hypertrophy can be to investigate diastolic functions. The most salient difference appeared in diastolic function, because E/A quotient was higher in the very active subjects than in the controls and it was the lowest in the obese persons.

Echocardiographic characteristics of male athletes of different age.

Two dimensionally guided M mode and Doppler echocardiographic data for 578 male subjects (106 non-athletic and 472 athletes) were analysed from two aspects: (a) in the young adult category (19--30 years of age), competitors in different groups of sports were studied; (b) in the different age groups (children, 10--14 years; adolescent juniors, 15--18 years; young adults, 19--30 years; adults, 31--44 years; older adults 45--60 years), data for athletes and non-athletes were compared. Morphological variables were related to body size by indices in which the exponents of the numerator and denominator were matched. Morphological signs of athletic heart were most consistently evident in the left ventricular muscle mass: in the young adult group, the highest values were seen in the endurance athletes, followed by the ball game players, sprinters/jumpers, and power athletes. A thicker muscular wall was the main reason for this hypertrophy. Internal diameter was only increased in the endurance athletes, and this increase was more evident in the younger groups. The E/A quotient (ratio of peak velocity during early and late diastole) indicated more effective diastolic function in the endurance athletes. The values for E/A quotient also suggested that regular physical activity at an older age may protect against age dependent impairment of diastolic function.

Echocardiographic changes in the development of the athlete' s heart in 9 to 20-year-old male subjects.

The purpose of this cross-sectional investigation was to estimate the age at which specific traits of the "athlete's heart" first appear and how they evolve from the beginning of regular physical training until young adulthood in healthy active males. Male athletes (n=389) and non-athletes (n=55) aged between 9 and 20 years were examined by two-dimensionally guided M-mode and Doppler echocardiography. Intragroup differences were examined by t-tests for independent samples between age groups of two years each. Morphologic variables were related to body size by using ratio indices in which the power terms of numerator and denominator were matched. Relative left ventricular muscle mass (LVMM) was significantly larger in the athletic males at age of 11-12, and this significant difference was maintained with advancing age. Most of this increase of LVMM could be attributed to the increase in wall thickness that became significantly manifest first in the 13- to 14-year-old athletic subjects but was demonstrable in all the other groups. A significantly larger left ventricular internal diameter was only found in the age-group of 15-16. Fractional shortening percentage (FS%) did not show any change, while resting heart rate was decreased in our athletic groups.

The effect of moderate weight loss on echocardiographic parameters in obese female patients.

Based on the data collected by KNOLL Hungary Ltd. in Hungary in 1999, 37% of the adult population is overweight while 23% is obese. Inappropriate diet containing excess calories and physical inactivity are responsible for these statistical values. In their former studies, the authors investigated the effects of different stages of obesity on the cardiovascular system, and have verified that even moderate obesity elicits pathological geometric and functional changes in the heart. In the present study, effect of a half-year-long life-style modification program on the morphologic and functional characteristics of the heart was investigated in twenty-one obese women. Life-style modification contained a diet with reduced energy uptake (1000-1300 Cal/day) and a regular physical training of minimum 3-4 hours weekly. By the end of the sixth month the weight loss was 5.1 kg (5.9%) on an average. There was a marked reduction in cardiac dimensions measured by echocardiography, with a very slight, non-significant decrease in left ventricular internal diameter, and a marked, significant reduction in the left ventricular wall thickness. Decrease of the left ventricular muscle mass exceeded the decrease of body weight. A marked elevation was found in the E/A quotient that reflected a definite improvement in diastolic function. Results indicate that physical training programs have a favourable effect on the echocardiographic parameters, therefore the process is reversible even without a pharmacological intervention.

[The combined effect of psychotherapy and fluoxetine on obesity]. / A pszichoterápia és a fluoxetin hatékonysága obesitasban.

Obesity as psychosomatic disease is a mass phenomenon. The number of obese males (BMI > 30) became doubled in the last ten years. In the etiology of obesity play an important role the reactive obesity. In the background of "yo-yo syndrome" often could be found depression, or other psychotic disorder. The low self-esteem, body dissatisfaction, tension, anxiety disorders is well-known in a slimming diet. Obese subjects (n = 29) who were admitted on their request with a view to losing weight were examined (Hamilton Depressive Scala, Hamilton Anxietas Scala, Eating Attitude Test) Physical Conditioning and internal Medicine Department of National Sports Medicine Institute, Budapest. Among obesities with mild and severe depression as treatment of somatic complications was used fluoxetine, in severe cases and depression with severe anxiety was associated with supportive or cognitive-behavioral treatment. The prevalence of binge eating disorders were at 57% and bulimia nervosa was at 3% in using population (n = 29). Decreasing of anxiety and grade of depression significantly correlated with body mass index (p < 0.023, F = 1.997, p < 0.034, F = 3.131). The treatment of fluoxetine significantly correlated with body mass index (T1: p < 0.023, T2: p < 0.03, T3: p < 0.004). The patients indicated their well being as fluoxetine reduced eating, satiety and lower binges.

Gender differences in the echocardiographic characteristics of the athletic heart.

Differences between males and females in the effects of regular physical training on the heart were investigated by echocardiography in 579 male (nonathletes: 122, athletes: 457) and in 336 (nonathletes: 84, athletes: 252) female subjects of variable age. The age groups were: children (<15 yr.), adolescent-young (15-18 yr.), young adult (19-30 yr.), adult (31-45 yr.) and people elder than 45 yr older (45<). Hypertrophy characterised by relative left ventricular muscle mass (rel.LVMM) of the athletic heart was manifest also in the females, but in comparison with the males female values were much lower both in the unconditioned and in the conditioned groups. In people belonging to the oldest groups no differences were seen either between the males and females or between athletes and nonathletes. In comparing nonathletic subjects, females showed smaller left ventricular contractility as reflected by a higher LVET/QT ratio and an increased ability of diastolic relaxation as indicated by a higher E/A ratio. Physical training induced a more marked development when the initial level was lower, namely, in the contractility of the females, and in the compliance of the males. No intersex difference was seen in the modified regulation of the athletic heart, characterised by a lower resting heart rate and slower circumferential shortening velocity (VCF).

Doppler echocardiographic examinations in the assessment of the athletic heart.

Doppler echocardiography is a method with the help of which flow velocity and the duration of different intervals can be estimated. The ratio between early and late peak velocities (E/A) is linearly proportional to diastolic function, i.e. to ventricular compliance. Data of 179 athletes and of 42 nontrained young healthy men indicated that the E/A quotient was higher in athletes than in the sedentary controls (2.086 +/- 0.505 vs. 1.905 +/- 0.384) in young adult age, but of the different athletes it was the only group of endurance athletes that showed a significant increase. Regular physical training seems to protect against an age-dependent impairment of left ventricular compliance, as an increased E/A ratio can be observed at the age of 31-45 years (1.77 +/- 0.46 vs. 1.43 +/- 0.276) as well as in men above 45 years of age (1.61 +/- 0.36 vs. 1.24 +/- 0.36). Bradycardia of the athletic heart resulted in a significantly longer duration of the cardiac cycle in athletes than in non-athletes. Different phases of the cardiac cycle, however, were not equally modified. There were periods the absolute duration of which were slightly decreased, unchanged or slightly increased, but the relative ones are strongly decreased: such as isovolumetric contraction time (ICT), acceleration of the transaortic flow (AOAT), deceleration of the transaortic flow (AODT), acceleration period of the early diastolic filling (EACC), and deceleration period of the early diastolic filling (EDT). There were periods the absolute duration of which increased proportionally to the increase of the whole cardiac cycle, while relative duration was not changed: isovolumetric contraction time (IVRT) and the atrial systole (A). There was one period that showed the greatest variability in the different subjects and both its absolute and relative duration was definitely increased in the athletes: this was the EA period, i.e. the period from the end of early filling to the beginning of the atrial systole.