Semmelweis University Heart and Vascular Center, Budapest, Hungary.
Department of Sports Medicine, Semmelweis University, Budapest, Hungary.
Am J Physiol Heart Circ Physiol. 2021 May 1;320(5):H1774-H1785. doi: 10.1152/ajpheart.00877.2020. Epub 2021 Mar 5.
Intense exercise exposes the heart to significant hemodynamic demands, resulting in adaptive changes in cardiac morphology and function. Nevertheless, the athletic adaptation of the atrioventricular valves remains to be elucidated. Our study aimed to characterize the geometry of mitral (MA) and tricuspid (TA) annuli in elite athletes using 3-D echocardiography. Thirty-four athletes presented with functional mitral regurgitation (FMR) were retrospectively identified and compared with 34 athletes without mitral regurgitation (MR) and 34 healthy, sedentary volunteers. 3-D echocardiographic datasets were used to quantify MA and TA geometry and leaflet tenting by dedicated softwares. MA and TA areas, as well as tenting volumes, were higher in athletes compared with controls. MA area was significantly higher in athletes with MR compared with those without (8.2 ± 1.0 vs. 7.2 ± 1.0 cm/m, < 0.05). Interestingly, athletes with MR also presented with a significantly higher TA area (7.2 ± 1.1 vs. 6.5 ± 1.1 cm/m, < 0.05). Nonplanar angle describing the MA's saddle shape was less obtuse in athletes without MR, whereas the values of athletes with MR were comparable with controls. The exercise-induced relative increases in left ventricular (35 ± 25%) and left atrial (40 ± 29%) volumes were similar; however, the increment in the MA area was disproportionately higher (63 ± 23%, overall < 0.001). The relative increase in TA area (40 ± 23%) was also higher compared with the increment in right ventricular volume (34 ± 25%, < 0.05). Atrioventricular annuli undergo a disproportionate remodeling in response to regular exercise. Athletic adaptation is characterized by both annular enlargement and increased leaflet tenting of both valves. There are differences in MA geometry in athletes presented with versus without FMR. We have characterized the annular geometry of mitral and tricuspid valves in elite athletes using 3-D echocardiography. We have found that exercise-induced remodeling of the atrioventricular annuli comprises a disproportionate dilation of annular dimensions and increased leaflet tenting of both valves. Moreover, we have demonstrated a more pronounced saddle shape of the mitral annulus in athletes without mitral regurgitation, which was not present in those who had mild regurgitation.
剧烈运动使心脏承受巨大的血流动力学需求，导致心脏形态和功能的适应性改变。然而，运动员的房室瓣适应性仍有待阐明。我们的研究旨在使用三维超声心动图描绘精英运动员的二尖瓣（MA）和三尖瓣（TA）环的几何形状。通过回顾性分析，我们确定了 34 名患有功能性二尖瓣反流（FMR）的运动员，并与 34 名无二尖瓣反流（MR）的运动员和 34 名健康、久坐的志愿者进行了比较。使用专用软件对三维超声心动图数据集进行定量分析，以量化 MA 和 TA 几何形状和瓣叶帐篷。与对照组相比，运动员的 MA 和 TA 面积以及帐篷体积均较高。与无 MR 的运动员相比，MR 患者的 MA 面积明显更高（8.2 ± 1.0 vs. 7.2 ± 1.0 cm/m， < 0.05）。有趣的是，MR 运动员的 TA 面积也明显更高（7.2 ± 1.1 vs. 6.5 ± 1.1 cm/m， < 0.05）。描述 MA 鞍形的非平面角度在无 MR 的运动员中较不钝角，而 MR 患者的数值与对照组相当。左心室（35 ± 25%）和左心房（40 ± 29%）体积的运动诱导相对增加相似；然而，MA 面积的增加不成比例地更高（63 ± 23%，整体 < 0.001）。TA 面积（40 ± 23%）的相对增加也高于右心室体积（34 ± 25%）的增加（ < 0.05）。房室瓣环对规律运动的反应表现出不成比例的重塑。运动适应性的特点是瓣环扩大和两个瓣膜的瓣叶帐篷增加。在有和无 FMR 的运动员中，MA 几何形状存在差异。我们使用三维超声心动图描绘了精英运动员的二尖瓣和三尖瓣瓣环的几何形状。我们发现，房室瓣环的运动诱导重塑包括环形尺寸的不成比例扩张和两个瓣的瓣叶帐篷增加。此外，我们在无二尖瓣反流的运动员中发现了更明显的二尖瓣环鞍形，而在轻度反流的运动员中则没有。
