diac Adaptation to Exerc diac Adaptation to Exerc chronic chronic Morphologi Morphologi cal cal • Myocardia Myocardia l l Function Function al al • Neural Neural
Jan 01, 2016
Cardiac Adaptation to ExerciseCardiac Adaptation to Exercisechronicchronic
MorphologicalMorphological
•MyocardialMyocardial
•VascularVascular
FunctionalFunctional
•NeuralNeural
Myocardial hypertrophyMyocardial hypertrophy
CoronariesCoronaries
MorphologicalMorphological
CRMSCRMS
Chronic Cardiac Chronic Cardiac Adaptation to ExerciseAdaptation to Exercise
Myocardial hypertrophyMyocardial hypertrophy•EccentricEccentric•ConcentricConcentric
Coronaries
MorphologicalMorphological
CRMSCRMS
Chronic Cardiac Chronic Cardiac Adaptation to ExerciseAdaptation to Exercise
Hypertrophia-Hyperplasia
• Hyperplasia constitutes an increase in the number of cells in an organ or tissue, which may then have increased volume.
• Hypertrophy refers to an increase in the size of cells and, with such change, an increase in the size of the organ
Myocardial hypertrophyMyocardial hypertrophy
pressure overloadpressure overload
Due to physical stimuliDue to physical stimuli
volume overloadvolume overload
Due to hormonal chemical stimuliDue to hormonal chemical stimuli
CRMSCRMS
Factors promoting Cardiac hypertrophy Factors promoting Cardiac hypertrophy Mechanical Force
CRMSCRMS
Development of Myocardial Development of Myocardial HypertrophyHypertrophy
Volume OverloadVolume Overload
Increased parietal Increased parietal diastolic stressdiastolic stress
Addition of sarcomer Addition of sarcomer in seriesin series
Increase chamber sizeIncrease chamber size
Eccentric HypertrophyEccentric Hypertrophy
Pressure OverloadPressure Overload
Increased parietal Increased parietal systolic stresssystolic stress
Addition of sarcomerAddition of sarcomer in parallelin parallel
Increase wall thicknessIncrease wall thickness
Concentric HypertrophyConcentric Hypertrophy
Collagen
CRMSCRMS
Effects of pressure/volume overload Effects of pressure/volume overload on cardiac structure and functionon cardiac structure and function
Exercise (Isometric-Isotonic)Exercise (Isometric-Isotonic)
Athletic HeartAthletic Heart
MyociteMyociteHypertrophyHypertrophy
AdeguateAdeguateCapillary densityCapillary density
Overload Volume/pressureOverload Volume/pressure
Cardiac remodellingCardiac remodellingIncrease contrattilityIncrease contrattility
CRMSCRMS
Effects of Training on Left VentricleEffects of Training on Left Ventricle
Adaptation of the Heart to Adaptation of the Heart to Exercise TrainingExercise Training
Adaptation of the Heart to Exercise Adaptation of the Heart to Exercise
ConcentricConcentric EccentricEccentric
NormalNormal
Calculation of Left Ventricle MassCalculation of Left Ventricle Mass
LVM(gr) =0,80x1,05x (IVS+PWT+LVID)3-LVID 3
CRMSCRMS
Anatomical Section Through Anatomical Section Through the Short Axis of Left Ventriclethe Short Axis of Left Ventricle
Short Axis View of Left Ventricle Short Axis View of Left Ventricle in Normal Subjectin Normal Subject
Short Axis View of Left VentricleShort Axis View of Left Ventriclein Athletein Athlete
Pathological HypertrophyPathological Hypertrophy
1.1. AgeAge2.2. GenderGender3.3. Type of stimulusType of stimulus4.4. Genetic heritageGenetic heritage
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
CRMSCRMS
• AgeAge
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
Left Ventricular Mass in young athletes ( soccer players): a cross
echocardiographic study
Giorgio Galanti M.D, Paolo Manetti M.D., Maria Concetta Vono M.D., Loira Toncelli
M.D., Paola Zilli M.D., Carlo Rostagno M.D., Vieri Boddi M.Sc.*, Natale Villari
M.D**,Roberto Salti M.D.
CRMSCRMS
• Purpose Purpose - Regular exercising induces changes in left ventricular - Regular exercising induces changes in left ventricular mass (LVM). While its effects in adults are well known, few data are mass (LVM). While its effects in adults are well known, few data are so far available on those in adolescents. so far available on those in adolescents.
• Methods -Methods - group of 127 young male soccer players (aged group of 127 young male soccer players (aged 13.6±2.1 yr., mean ± standard deviation) was studied. They had been 13.6±2.1 yr., mean ± standard deviation) was studied. They had been regularly playing soccer since they were six years old. Players were regularly playing soccer since they were six years old. Players were age-matched with 70 male sedentary adolescents. LVM was age-matched with 70 male sedentary adolescents. LVM was detected with echocardiography and body composition with detected with echocardiography and body composition with bioelectrical impedance analysis. Pubertal stadiation was evaluated bioelectrical impedance analysis. Pubertal stadiation was evaluated with the Tanner method and skeletal maturation with hand x-ray. with the Tanner method and skeletal maturation with hand x-ray.
Results Results - Skeletal age, Tanner maturation and weight were - Skeletal age, Tanner maturation and weight were comparable in the two groups, while height (p=0.002), fat-free mass comparable in the two groups, while height (p=0.002), fat-free mass
(FFM, p<0.0005) and cellular body mass (p=0.002) were higher in (FFM, p<0.0005) and cellular body mass (p=0.002) were higher in athletes. Players showed increased LVM as compared with controls athletes. Players showed increased LVM as compared with controls (159±49 vs. 137±42 g, p=0.002; confirmed by measures of LVM/body (159±49 vs. 137±42 g, p=0.002; confirmed by measures of LVM/body
surface area: 97±19 g/msurface area: 97±19 g/m22 vs. 87±17 g/m vs. 87±17 g/m22, p<0.0005, respectively). , p<0.0005, respectively). Starting from similar values, LVM progressively increased more in Starting from similar values, LVM progressively increased more in players than in controls after 12 yr. (Tanner 2), reaching statistical players than in controls after 12 yr. (Tanner 2), reaching statistical
significance at 15.4 yr. (Tanner 5). In both athletes and controls LVM significance at 15.4 yr. (Tanner 5). In both athletes and controls LVM was directly correlated with all the anthropometric and was directly correlated with all the anthropometric and
cardiovascular parameters examined (p<0.0005). At multivariate cardiovascular parameters examined (p<0.0005). At multivariate analysis LVM was significantly correlated with skeletal age (b=8.54), analysis LVM was significantly correlated with skeletal age (b=8.54), height (b=1.77) in athletes, and with skeletal age (b=4.83) and FFM height (b=1.77) in athletes, and with skeletal age (b=4.83) and FFM
(b=1.83) in controls. (b=1.83) in controls.
Conclusions
• Our data suggest that exercise induces a Our data suggest that exercise induces a physiological left ventricular physiological left ventricular hypertrophy in sportive population. hypertrophy in sportive population.
• This hypertrophy becomes evident after This hypertrophy becomes evident after sexual maturation was achieved.sexual maturation was achieved.
Type of stimulusType of stimulus
CRMSCRMS
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
Circulation Reasearch 2001
Genetic HeritageGenetic Heritage
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
•42 elite soccer male players (from 17 to 31 years old)
•45 age matched healthy male controls
All were studied with echocardiography and DNA analysis
Studied SubjetsStudied SubjetsAllelic Frequency AnalysisAllelic Frequency Analysis
G.Galanti et al. MSSE Nov:2000
Correlation between Left Ventricular Mass (LVM) and I/D Polimorphysm
Athletes withincreased LVM Genotype
DD + ID 14 5
II 0 3
p<0,05
Athletes withoutincreased LVM
G.Galanti et al. MSSE Nov:2000
CONCLUSIONSCONCLUSIONS
• Increase of left ventricular mass is correlated Increase of left ventricular mass is correlated with I/D polimorphism: The DD athletes had with I/D polimorphism: The DD athletes had shown an increase while the II athletes had a shown an increase while the II athletes had a reduction. reduction.
• Increase of left ventricular mass is not Increase of left ventricular mass is not correlated with A/C polimorphism:correlated with A/C polimorphism:
G.Galanti et al. MSSE Nov:2000G.Galanti et al. MSSE Nov:2000 CRMSCRMS
CRMSCRMS
La scelta dello sport è La scelta dello sport è geneticamente determinata?geneticamente determinata?
Association of angiotensin-converting enzyme gene I/DAssociation of angiotensin-converting enzyme gene I/Dpolymorphism with change in left ventricular mass inpolymorphism with change in left ventricular mass inresponse to physical trainingresponse to physical training
Montgomery H, Clarkson P et alCirculation 1997, 96: 741-747)
Soggetti StudiatiSoggetti Studiati
I soggetti studiati comprendevano I soggetti studiati comprendevano
136136 atleti allenati (età media 24±3.5 atleti allenati (età media 24±3.5
anni) tra i quali 121 erano anni) tra i quali 121 erano calciatoricalciatori
(85 maschi, 36 femmine) e 15 (85 maschi, 36 femmine) e 15
ciclisticiclisti (maschi), confrontati con (maschi), confrontati con
155155 controlli, sedentari, controlli, sedentari,
comparabili per sesso ed età.comparabili per sesso ed età.
CRMSCRMS
RisultatiRisultatifrequenza allelicafrequenza allelica
La distribuzione del genotipo La distribuzione del genotipo
è risultata in accordo con è risultata in accordo con
l'equilibrio di Hardy-Weinberg l'equilibrio di Hardy-Weinberg
e la frequenza allelica è e la frequenza allelica è
risultata comparabile nei due risultata comparabile nei due
gruppi. gruppi.
Non sono state evidenziate Non sono state evidenziate
differenze significative differenze significative
comparando la distribuzione comparando la distribuzione
dei genotipi nei vari tipi di dei genotipi nei vari tipi di
sport.sport.
CRMSCRMS
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
CRMSCRMS
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
Types of Myocardial Types of Myocardial HypertrophyHypertrophy
Normal
Adeguate NonAdeguateAdeguate
Variability of wall thickness in Variability of wall thickness in elite athleteselite athletes
0
50
100
150
200
250
300
8 9 10 11 12 13 14
N° AthlN° Athl
Wall Thickness Wall Thickness mmmm
Pelliccia.NEJM.1991
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
Exercise EchocardiographyExercise Echocardiography
1.1. Increse Ejection fractionIncrese Ejection fraction2.2. Decreased Left Systolic Decreased Left Systolic
Ventricular Volume Ventricular Volume 3.3. No significant modifications of No significant modifications of
Wall Stress Wall Stress
Modifications during Exercise Modifications during Exercise EchocardiographyEchocardiography
CRMSCRMS
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic FunctionNormal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
DIASTOLIC FUNCTION IN DIASTOLIC FUNCTION IN ATHLETESATHLETES
ATHLETES CONTROLS
LVM gr/m2 208±28* 112±21
IVR msec 69±12* 76±11
DT msec 171±72 203±31
Ep cm/sec 84±12* 85±19
Ap cm/sec 41±8* 56±15
Galanti et al, Angiology 1992 4:315-20
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
Regression of Athlete’s Regression of Athlete’s HypertrophyHypertrophy
0
50
100
150
200
250
LVM(gr) LVID(mm)
ContrAth BeAth Af
G.Galanti et al. Cardiologia 1989
Cardiac Adaptation to ExerciseCardiac Adaptation to Exercisechronicchronic
Myocardial hypertrophy•Eccentric•Concentric
CoronariesCoronaries
MorphologicalMorphological
CRMSCRMS
Coronary Arteries
Left Coronary in AthleteLeft Coronary in Athlete
Rigth Coronary in AthleteRigth Coronary in Athlete
Cardiac Adaptation to ExerciseCardiac Adaptation to Exercisechronicchronic
FunctionalFunctional Heart RateHeart Rate
H.R. b/min
Recovery
Cycloergometer
Cardiovascular Response to Cardiovascular Response to Acute Exercise in trained subjectsAcute Exercise in trained subjects