Bohm Philipp, Schneider Günther, Linneweber Lutz, Rentzsch Axel, Krämer Nadine, Abdul-Khaliq Hashim, Kindermann Wilfried, Meyer Tim, Scharhag Jürgen
From Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany (P.B., L.L., N.K., W.K., T.M., J.S.); Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany (G.S.); and Clinic of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany (A.R., H.A.-K.).
Circulation. 2016 May 17;133(20):1927-35. doi: 10.1161/CIRCULATIONAHA.115.020975. Epub 2016 Apr 12.
It is under debate whether the cumulative effects of intensive endurance exercise induce chronic cardiac damage, mainly involving the right heart. The aim of this study was to examine the cardiac structure and function in long-term elite master endurance athletes with special focus on the right ventricle by contrast-enhanced cardiovascular magnetic resonance.
Thirty-three healthy white competitive elite male master endurance athletes (age range, 30-60 years) with a training history of 29±8 years, and 33 white control subjects pair-matched for age, height, and weight underwent cardiopulmonary exercise testing, echocardiography including tissue-Doppler imaging and speckle tracking, and cardiovascular magnetic resonance. Indexed left ventricular mass and right ventricular mass (left ventricular mass/body surface area, 96±13 and 62±10 g/m(2); P<0.001; right ventricular mass/body surface area, 36±7 and 24±5 g/m(2); P<0.001) and indexed left ventricular end-diastolic volume and right ventricular end-diastolic volume (left ventricular end-diastolic volume/body surface area, 104±13 and 69±18 mL/m(2); P<0.001; right ventricular end-diastolic volume/body surface area, 110±22 and 66±16 mL/m(2); P<0.001) were significantly increased in athletes in comparison with control subjects. Right ventricular ejection fraction did not differ between athletes and control subjects (52±8 and 54±6%; P=0.26). Pathological late enhancement was detected in 1 athlete. No correlations were found for left ventricular and right ventricular volumes and ejection fraction with N-terminal pro-brain natriuretic peptide, and high-sensitive troponin was negative in all subjects.
Based on our results, chronic right ventricular damage in elite endurance master athletes with lifelong high training volumes seems to be unlikely. Thus, the hypothesis of an exercise-induced arrhythmogenic right ventricular cardiomyopathy has to be questioned.
高强度耐力运动的累积效应是否会导致慢性心脏损伤，主要累及右心，目前仍存在争议。本研究的目的是通过对比增强心血管磁共振成像，特别关注右心室，来检查长期优秀的老年耐力运动员的心脏结构和功能。
33名健康的白人男性优秀老年耐力运动员（年龄范围30 - 60岁，训练史29±8年），以及33名年龄、身高和体重匹配的白人对照者接受了心肺运动测试、包括组织多普勒成像和斑点追踪的超声心动图检查以及心血管磁共振成像。与对照者相比，运动员的左心室质量指数和右心室质量指数（左心室质量/体表面积，96±13和62±10 g/m²；P<0.001；右心室质量/体表面积，36±7和24±5 g/m²；P<0.001）以及左心室舒张末期容积指数和右心室舒张末期容积指数（左心室舒张末期容积/体表面积，104±13和69±18 mL/m²；P<0.001；右心室舒张末期容积/体表面积，110±22和66±16 mL/m²；P<0.001）显著增加。运动员和对照者之间的右心室射血分数无差异（52±8和54±6%；P = 0.26）。1名运动员检测到病理性延迟强化。左心室和右心室容积及射血分数与N末端脑钠肽前体无相关性，所有受试者的高敏肌钙蛋白均为阴性。
基于我们的研究结果，终身高训练量的优秀耐力老年运动员发生慢性右心室损伤的可能性似乎不大。因此，运动诱发致心律失常性右心室心肌病这一假说值得质疑。
