D'Andrea Antonello, Limongelli Giuseppe, Caso Pio, Sarubbi Berardo, Della Pietra Angelo, Brancaccio Paola, Cice Gennaro, Scherillo Marino, Limongelli Francesco, Calabrò Raffaele
Department of Cardiology, Second University of Naples, Italy.
Int J Cardiol. 2002 Dec;86(2-3):177-84. doi: 10.1016/s0167-5273(02)00194-8.
The aim of the study was to evaluate in 263 competitive athletes possible correlations between changes induced by different sport activities in left ventricular (LV) structure and cardiac response during maximal physical effort.
A total of 160 top-level endurance athletes (ATE; swimmers, runners; 28+/-4 years; 98 male) and 103 strength-trained athletes (ATS; weight-lifters, body-builders; 27+/-5 years; male), selected on the basis of training protocol (dynamic vs. static exercise), underwent standard Doppler echocardiography, heart rate variability analysis and maximal exercise stress test by bicycle ergometry. M- and B-mode echocardiographic LV measurements were determined at rest, while the following functional indexes were assessed during effort: maximal heart rate (HR), maximal systolic blood pressure (SBP) and maximal workload (Watts reached by bicycle test).
The two groups were comparable for age and sex, but ATS at rest showed higher HR, SBP, and body surface area (BSA). By echo analysis, LV mass index and ejection fraction did not significantly differ between the two groups. However, ATS showed increased sum of wall thickness (septum+posterior wall), relative wall thickness and LV end-systolic stress, while LV stroke volume and LV end-diastolic diameter (P<0.01) were greater in ATE. HR variability analysis underlined in ATE increased indexes of vagal tone (P<0.01). During maximal physical effort, ATE showed a better functional capacity, with greater maximal workload (P<0.001) reached with lower maximal HR and SBP. After adjusting for HR, age, sex, BSA and SBP, distinct multiple linear regression models evidenced in ATE independent associations of maximal effort workload with LV end-diastolic diameter (P<0.001), HR (P<0.001) at rest and LV end-systolic stress (P<0.01) were found in ATE. On the other hand, independent direct correlation of SBP max during effort with sum of wall thickness (P<0.001), BSA (P<0.05) and LV end-systolic stress (P<0.001) was evidenced in ATS.
LV structural changes in competitive athletes represent adaptation to hemodynamic overload induced by training and are consistent with different kinds of sport activity. Work capacity during exercise is positively influenced by preload increase in ATE, while increased afterload due to isometric training in ATS determines higher systemic resistance during physical effort.
本研究旨在评估263名竞技运动员在不同体育活动引起的左心室（LV）结构变化与最大体力运动时心脏反应之间可能存在的相关性。
根据训练方案（动态运动与静态运动）选取了160名顶级耐力运动员（ATE；游泳运动员、跑步运动员；28±4岁；98名男性）和103名力量训练运动员（ATS；举重运动员、健美运动员；27±5岁；男性），对他们进行标准多普勒超声心动图检查、心率变异性分析以及通过自行车测力计进行最大运动应激试验。在静息状态下测定M型和B型超声心动图的左心室测量值，同时在运动过程中评估以下功能指标：最大心率（HR）、最大收缩压（SBP）和最大工作量（自行车试验达到的瓦特数）。
两组在年龄和性别方面具有可比性，但静息状态下ATS的HR、SBP和体表面积（BSA）较高。通过超声心动图分析，两组之间的左心室质量指数和射血分数无显著差异。然而，ATS的室壁厚度总和（室间隔+后壁）、相对室壁厚度和左心室收缩末期应力增加，而ATE的左心室每搏输出量和左心室舒张末期内径更大（P<0.01）。心率变异性分析显示ATE的迷走神经张力指数增加（P<0.01）。在最大体力运动期间，ATE表现出更好的功能能力，在较低的最大HR和SBP下达到更大的最大工作量（P<0.001）。在对HR、年龄、性别、BSA和SBP进行校正后，不同的多元线性回归模型显示，在ATE中，最大运动工作量与左心室舒张末期内径（P<0.001）、静息HR（P<0.001）和左心室收缩末期应力（P<0.01）存在独立关联。另一方面，在ATS中，运动期间的最大SBP与室壁厚度总和（P<0.001）、BSA（P<0.05）和左心室收缩末期应力（P<0.001）存在独立直接相关性。
竞技运动员的左心室结构变化代表了对训练引起的血流动力学过载的适应，并且与不同类型的体育活动一致。运动能力在ATE中受到前负荷增加的积极影响，而在ATS中，由于等长训练导致的后负荷增加决定了体力运动期间更高的全身阻力。
