Federico Alvino

Morphological and Functional Adaptation of Left and Right Atria Induced by Training in Highly Trained Female Athletes

Background—Exercise is able to induce atrial remodeling in top-level athletes. However, evidence is mainly limited to men and based on cross-sectional studies. The aim of this prospective, longitudinal study was to investigate whether exercise is able to influence left and right atrial morphology and function also in female athletes. Methods and Results—Two-dimensional echocardiography was performed before season and after 16 weeks of intensive training in 24 top-level female athletes. Left and right atrial myocardial deformation was assessed by two-dimensional speckle-tracking echocardiography. Left atrial volume index (24.0±3.6 versus 26.7±6.9 mL/m2; P<0.001) and right atrial volume index (15.66±3.09 versus 20.47±4.82 mL/m2; P<0.001) significantly increased after training in female athletes. Left atrial global peak atrial longitudinal strain and peak atrial contraction strain significantly decreased after training in female athletes (43.9±9.5% versus 39.8±6.5%; P<0.05 and 15.5±4.0% versus 13.9±4.0%; P<0.05, respectively). Right atrial peak atrial longitudinal strain and peak atrial contraction strain showed a similar, although non-significant decrease (42.8±10.6% versus 39.3±8.3%; 15.6±5.6% versus 13.1±6.1%, respectively). Neither biventricular E/e′ ratio nor biatrial stiffness changed after training, suggesting that biatrial remodeling occurs in a model of volume rather than pressure overload. Conclusions—Exercise is able to induce biatrial morphological and functional changes in female athletes. Biatrial enlargement, with normal filling pressures and low atrial stiffness, is a typical feature of the heart of female athletes. These findings should be interpreted as physiological adaptations to exercise and should be considered in the differential diagnosis with cardiomyopathies.

Right ventricular remodelling induced by exercise training in competitive athletes

AIMS Conflicting evidence exists concerning right ventricular (RV) morphological and functional remodelling in trained athletes, with a very few longitudinal data prospectively investigating the RV changes. The aim of this study was to assess the morphological and functional RV changes occurring during the competitive season in young athletes engaged in the most popular team sports. METHODS AND RESULTS Twenty-nine top-level athletes (age: 20.9 ± 6.7 years), practicing basketball and volleyball, were evaluated at pre-season, mid-season, and end-season time-points, using tissue Doppler imaging and 2D speckle-tracking echocardiography. RV basal and mid-cavity end-diastolic diameters (EDDs; overall P = 0.011 and P < 0.0001, respectively), and RV diastolic area (overall P < 0.0001) increased during the season. Conversely, RV outflow tract did not vary (overall P = 0.96). During the season, no significant differences were observed in RV diastolic functional indexes and in RV fractional area change (overall P = 0.35). Global RV longitudinal strain did not significantly change (overall P = 0.52), although apical longitudinal strain significantly increased (overall P = 0.017). In association, left ventricular (LV) volume and mass increased during the season (overall P = 0.007). On multivariate analysis, LV mass was the only independent predictor of RVEDD at pre-season (β = 0.69, P < 0.0001) and at end-season (β = 0.82, P < 0.0001). CONCLUSIONS Right ventricular chamber size increases during the competitive season in top-level athletes, with no significant changes in the outflow tract. RV morphological adaptation in top-level athletes practicing team sports is not associated with a reduction in RV function or in myocardial deformation and occurs in close association with changes on the left ventricle, suggesting a physiological remodelling of the right ventricle.

Left Ventricular Twisting Modifications in Patients with Left Ventricular Concentric Hypertrophy at Increasing After-Load Conditions

Left ventricular hypertrophy (LVH) develops as a result of several clinical conditions, such as intensive training, hypertension, aortic valve stenosis. Aim of this study was to analyze the left ventricular twist (LVT) modifications in LVH patients with increasing after‐load conditions.

Effects of training on LV strain in competitive athletes

Objective LV longitudinal strain, a recognised marker of LV function, has been recently applied to the evaluation of the athletes heart. At present, little is known about the influence of training on LV global longitudinal strain (GLS) in athletes. The aim of this study was to prospectively investigate the impact of training on LV longitudinal strain and twist mechanics in a cohort of competitive athletes. Methods Ninety-one competitive athletes, practising team sports and competing at national or international level, were analysed. Echocardiographic evaluation was performed at the beginning of the season (low training) and after 18±2 weeks of a supervised, intensive training programme (peak training). Results A significant increase in LV mass (p<0.0001), LV end-diastolic and end-systolic volume (p=0.0001 and <0.0001, respectively) was found at peak training. LV basal and apical torsion (p=0.59 and 0.43, respectively) and LV twisting (p=0.78) did not change, and only a mild increase in LV GLS was evident after training (p=0.044). Resting heart rate was identified as the only independent predictor of LV GLS after training (β=0.30, p=0.005). Conclusions A 18-week, intensive training programme induced only a slight increase in LV GLS despite marked changes in cardiac morphology, suggesting a physiological adaptation of the LV to exercise conditioning.

Precompetitive assessment of heart rate variability in elite female athletes during play offs.

Heart rate variability (HRV) has been rarely applied in elite athletes prior to competition. The aim of this study was to examine the changes in HRV in elite female volleyball players before a stressful match during play offs and to evaluate the impact on sport‐specific performance.

The prevalence and clinical significance of premature ventricular beats in the athlete.

Adolescents and adults with cardiovascular disease who are engaged in sports activity have an increased risk of sudden cardiac death (SCD) that is three times greater than that of their non‐athletic counterparts. Sport acts as a trigger for cardiac arrest in the presence of underlying cardiovascular diseases predisposing to life‐threatening ventricular arrhythmias. Frequent and complex premature ventricular beats (PVBs) detected during the cardiovascular screening of the athletic population may be a sign of an underlying cardiovascular disease at risk of SCD, but are also often recorded in trained athletes without cardiovascular abnormalities. Thus, the interpretation of PVBs could represent a clinical dilemma, particularly in the athlete. However, while some characteristics of PVBs can be considered common and benign, others occur uncommonly in the athletic population and raise the suspicion of an underlying cardiovascular disease. This review discusses the prevalence and clinical significance of PVBs in the athlete, with a focus on exercise‐induced PVBs, on the analysis of PVBs morphology at 12‐lead ECG, and on the morphological substrates identified by imaging techniques. The implications on eligibility for competitive sports participation are also discussed, according to the relevance of PVB detection for disqualifying athletes from competitions.

Cardiovascular risk profile in Olympic athletes: an unexpected and underestimated risk scenario

Background Prevalence of cardiovascular (CV) risk factors has been poorly explored in subjects regularly engaged in high-intensity exercise programmes. Our aim was, therefore, to assess the prevalence and distribution of CV risk factors in a large population of competitive athletes, to derive the characteristics of athlete’s lifestyle associated with the best CV profile. Methods 1058 Olympic athletes (656 males, 402 females), consecutively evaluated in the period 2014–2016, represent the study population. Prevalence and distribution of CV risk factors was assessed, in relation to age, body size and sport. Findings Dyslipidemia was the most common risk (32%), followed by increased waist circumference (25%), positive family history (18%), smoking habit (8%), hypertension (3.8%) and hyperglycaemia (0.3%). Large subset of athletes (418, 40%) had none or 1 (414, 39%) risk factor, while only a few (39, 3.7%) had 3/4 CV risk factors. The group without risks largely comprised endurance athletes (34%). Ageing was associated with higher total and low-density lipoprotein cholesterol, triglycerides (p<0.001) and glycaemia (p=0.002) and lower high-density lipoprotein cholesterol. On multivariate logistic regression analysis, age, BMI and body fat were identified as independent predictors of increased CV risk. Interpretation Dyslipidemia and increased waist circumference are common in elite athletes (32% and 25%, respectively). A large proportion (40%) of athletes, mostly endurance, are totally free from risk factors. Only a minority (3%) presents a high CV risk, largely expression of lifestyle and related to modifiable CV risk factors.