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Abstract

Aim

In this study we sought to assess whether in elite athletes the physiological increase in cardiac mass attending severe long-term training leading to athlete's heart is accompanied by an improvement of autonomic performance, as assessed by post exercise vagal indices and a novel unitary Autonomic Nervous System Index for sports (ANSIs).

Methods

The study involved 500 elite athletes (23.9 ± 6.4 years) participating in a screening organised by the National Italian Olympic Committee. All subjects underwent a complete medical examination, rest and stand autonomic assessment (heart rate variability) as well as bicycle exercise. ANSIs was also derived as radar plot from rest, stand and heart rate recovery individual proxies of autonomic nervous system regulation. All subjects were grouped into those with left ventricular hypertrophy present (LVH(+)), or not (LVH(–)), according to recognised thresholds.

Results

We observed that LVH(+) athletes (24.8%) showed a marked increase of post-exercise vagal indices (p < 0.001) and of ANSIs (p < 0.001), while no difference was observed for heart-rate variability indices. These changes were contingent upon sport intensity categories.

Conclusions

Elite athletes with physiological cardiac hypertrophy (LVH(+)) present a selective profile of indices of autonomic nervous system performance, characterised by increases of markers of vagal recovery and of the novel unitary autonomic index for sports while RR variance and spectral indices seem to be unmodified. Athlete's heart may be characterised by a specific combination of anatomical and neurocardiac remodeling. This approach might furnish potential warning signs differentiating normal training induced physiology from pathological adaptation.

Keywords

Elite athlete exercise training autonomic regulation echocardiography cardiac hypertrophy vagal recovery

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References

George

Whyte

Green

et al.

The endurance athletes heart: Acute stress and chronic adaptation. Br J Sports Med 2012; 46: i29–i36.

Pelliccia A, Caselli S, Sharma S, et al. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: Recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J 2018; 39: 1949–1969.

Caselli

Montesanti

Autore

et al.

Patterns of left ventricular longitudinal strain and strain rate in Olympic athletes. J Am Soc Echocardiogr 2015; 28: 245–253.

Mitchell

Haskell

Snell

et al.

Task force 8: Classification of sports. J Am Coll Cardiol 2005; 45: 1364–1367.

Barbier

Lebiller

Ville

et al.

Relationships between sports-specific characteristics of athlete's heart and maximal oxygen uptake. Eur J Cardiovasc Prev Rehabil 2006; 13: 115–121.

Dixon

Kamath

McCartney

et al.

Neural regulation of heart rate variability in endurance athletes and sedentary controls. Cardiovasc Res 1992; 26: 713–719.

D'Souza

Bucchi

Johnsen

et al.

Exercise training reduces resting heart rate via downregulation of the funny channel HCN4. Nat Commun 2014; 5: 3775.

Pagani

Lombardi

Guzzetti

et al.

Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 1986; 59: 178–193.

Buchheit

. Monitoring training status with HR measures: Do all roads lead to Rome?. Front Physiol 2014; 5: 73, .

10.

Malliani

Pagani

Lombardi

et al.

Cardiovascular neural regulation explored in the frequency domain. Circulation 1991; 84: 482–492.

11.

Sala

Malacarne

Tosi

et al.

May a unitary autonomic index help assess autonomic cardiac regulation in elite athletes? Preliminary observations on the National Italian Olympic Committee Team. J Sports Med Phys Fitness 2017; 57: 1702–1710.

12.

Iellamo

Pigozzi

Spataro

et al.

Autonomic and psychological adaptations in Olympic rowers. J Sports Med Phys Fitness 2006; 46: 598–604.

13.

Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Heart-Rate Variability: Standards of measurements, physiological interpretation and clinical use. Circulation 1996; 93: 1043–1065.

14.

Corrado

Pelliccia

Heidbuchel

et al.

Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243–259.

15.

Lucini

Sala

Spataro

et al.

Can the use of a single integrated unitary autonomic index provide early clues for eventual eligibility for Olympic games?. Eur J Appl Physiol 2018; 118: 919–926.

16.

Lucini

Mela

Malliani

et al.

Impairment in cardiac autonomic regulation preceding arterial hypertension in humans: Insights from spectral analysis of beat-by-beat cardiovascular variability. Circulation 2002; 106: 2673–2679.

17.

Toninelli

Vigo

Vaglio

et al.

DynaScope: A software tool for the analysis of heart rate variability during exercise. Comput Cardiol 2012; 39: 181–184.

18.

Lang

Badano

Mor-Avi

et al.

Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: 1–39.

19.

Maron

. Sudden death in young athletes. N Engl J Med 2003; 349: 1064–1075.

20.

Pelliccia

Maron

Spataro

et al.

The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991; 324: 295–301.

21.

Finocchiaro

Dhutia

DGÇÖ Silva

et al.

Effect of sex and sporting discipline on LV adaptation to exercise. JACC Cardiovasc Imaging 2017; 10: 965–972.

22.

Plews

Laursen

Stanley

et al.

Training adaptation and heart rate variability in elite endurance athletes: Opening the door to effective monitoring. Sports Med 2013; 43: 773–781.

23.

Legramante

Pigozzi

et al.

Conversion from vagal to sympathetic predominance with strenuous training in high-performance world class athletes. Circulation 2002; 105: 2719–2724.

24.

Chalencon

Pichot

Roche

et al.

Modeling of performance and ANS activity for predicting future responses to training. Eur J Appl Physiol 2015; 115: 589–596.

25.

Manzi

Castagna

Padua

et al.

Dose-response relationship of autonomic nervous system responses to individualized training impulse in marathon runners. Am J Physiol Heart Circ Physiol 2009; 296: H1733–H1740.

26.

Pecanha

Bartels

Brito

et al.

Methods of assessment of the post-exercise cardiac autonomic recovery: A methodological review. Int. J Cardiol 2017; 227: 795–802.

27.

Lamberts

Swart

Capostagno

et al.

Heart rate recovery as a guide to monitor fatigue and predict changes in performance parameters. Scand J Med Sci Sports 2010; 20: 449–457.

28.

Pluim

Swenne

Zwinderman

et al.

Correlation of heart rate variability with cardiac functional and metabolic variables in cyclists with training induced left ventricular hypertrophy. Heart 1999; 81: 612–617.

29.

Kouidi

Haritonidis

Koutlianos

et al.

Effects of athletic training on heart rate variability triangular index. Clin Physiol Funct Imaging 2002; 22: 279–284.

30.

Lucini

Marchetti

Spataro

et al.

Heart rate variability to monitor performance in elite athletes: Criticalities and avoidable pitfalls. Int J Cardiol 2017; 240: 307–312.

31.

Lucini

Solaro

Pagani

. Autonomic differentiation map: A novel statistical tool for interpretation of heart rate variability. Front Physiol 2018; 9: 401.

32.

White

Raven

. Autonomic neural control of heart rate during dynamic exercise: Revisited. J Physiol 2014; 592: 2491–2500.

33.

Warner

Russel

. Effect of combined sympathetic and vagal stimulation on heart rate in the dog. Jr Circ Res 1969; 24: 567–573.

34.

Kohara

Hara-Nakamura

Hiwada

. Left ventricular mass index negatively correlates with heart rate variability in essential hypertension. Am. J Hypertens 1995; 8: 183–188.

35.

Alter

Grimm

Vollrath

et al.

Heart rate variability in patients with cardiac hypertrophy–relation to left ventricular mass and etiology. Am Heart J 2006; 151: 829–836.

36.

Luijkx

Velthuis

Prakken

et al.

Impact of revised task force criteria: Distinguishing the athlete's heart from ARVC/D using cardiac magnetic resonance imaging. Eur J Prev Cardiol 2012; 19: 885–891.

37.

Kiss

Sydo

Vargha

et al.

Detailed heart rate variability analysis in athletes. Clin Auton Res 2016; 26: 245–252.

38.

Pressler

Suchy

Friedrichs

et al.

Running multiple marathons is not a risk factor for premature subclinical vascular impairment. Eur J Prev Cardiol 2017; 24: 1328–1335.

39.

Lindgren

Åberg

Schaufelberger

et al.

Cardiorespiratory fitness and muscle strength in late adolescence and long-term risk of early heart failure in Swedish men. Eur J Prev Cardiol 2017; 24: 876–884.

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Left ventricular hypertrophy in world class elite athletes is associated with signs of improved cardiac autonomic regulation

Abstract

Aim

Methods

Results

Conclusions

Keywords

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References

Supplementary Material