Regression of Left Ventricular Mass in Athletes Undergoing Complete Detraining Is Mediated by Decrease in Intracellular but Not Extracellular Compartments

Overview

Journal Circ Cardiovasc Imaging

Specialties Cardiology & Vascular Diseases
Radiology

Date 2019 Sep 12

PMID 31505947

Citations 8

Authors

Peter P Swoboda

Pankaj Garg

Eylem Levelt

David A Broadbent

Ashkun Zolfaghari-Nia

A James R Foley

Graham J Fent

Pei G Chew

Louise A Brown

Christopher E Saunderson

Erica DallArmellina

John P Greenwood

Sven Plein

Affiliations

Soon will be listed here.

Abstract

Background: Athletic cardiac remodeling can occasionally be difficult to differentiate from pathological hypertrophy. Detraining is a commonly used diagnostic test to identify physiological hypertrophy, which can be diagnosed if hypertrophy regresses. We aimed to establish whether athletic cardiac remodeling assessed by cardiovascular magnetic resonance is mediated by changes in intracellular or extracellular compartments and whether this occurs by 1 or 3 months of detraining.

Methods: Twenty-eight athletes about to embark on a period of forced detraining due to incidental limb bone fracture underwent clinical assessment, ECG, and contrast-enhanced cardiovascular magnetic resonance within a week of their injury and then 1 month and 3 months later.

Results: After 1 month of detraining, there was reduction in left ventricular (LV) mass (130±28 to 121±25 g; <0.0001), increase in native T1 (1225±30 to 1239±30 ms; =0.02), and extracellular volume fraction (24.5±2.3% to 26.0±2.6%; =0.0007) with no further changes by 3 months. The decrease in LV mass was mediated by a decrease in intracellular compartment volume (94±22 to 85±19 mL; <0.0001) with no significant change in the extracellular compartment volume. High LV mass index, low native T1, and low extracellular volume fraction at baseline were all predictive of regression in LV mass in the first month.

Conclusions: Regression of athletic LV hypertrophy can be detected after just 1 month of complete detraining and is mediated by a decrease in the intracellular myocardial compartment with no change in the extracellular compartment. Further studies are needed in athletes with overt and pathological hypertrophy to establish whether native T1 and extracellular volume fraction may complement electrocardiography, echocardiography, cardiopulmonary exercise testing, and genetic testing in predicting the outcome of detraining.

Citing Articles

Exercise and the Heart: Benefits, Risks and Adverse Effects of Exercise Training.

Mannakkara N, Finocchiaro G Rev Cardiovasc Med. 2024; 24(3):94.

PMID: 39077491 PMC: 11264002. DOI: 10.31083/j.rcm2403094.

Detraining among Athletes-Is Withdrawal of Adaptive Cardiovascular Changes a Hint for the Differential Diagnosis of Physically Active People?.

Zujko-Kowalska K, Kaminski K, Malek L J Clin Med. 2024; 13(8).

PMID: 38673615 PMC: 11050872. DOI: 10.3390/jcm13082343.

CMR Mapping: The 4th-Era Revolution in Cardiac Imaging.

Carrabba N, Amico M, Guaricci A, Carella M, Maestrini V, Monosilio S J Clin Med. 2024; 13(2).

PMID: 38256470 PMC: 10816333. DOI: 10.3390/jcm13020337.

Identification of non-ischaemic fibrosis in male veteran endurance athletes, mechanisms and association with premature ventricular beats.

Farooq M, Brown L, Fitzpatrick A, Broadbent D, Wahab A, Klassen J Sci Rep. 2023; 13(1):14640.

PMID: 37669972 PMC: 10480152. DOI: 10.1038/s41598-023-40252-z.

Flat Magnetic Stimulation for Stress Urinary Incontinence: A 3-Month Follow-Up Study.

Barba M, Cola A, Rezzan G, Costa C, Melocchi T, De Vicari D Healthcare (Basel). 2023; 11(12).

PMID: 37372848 PMC: 10298542. DOI: 10.3390/healthcare11121730.

References

Swoboda P, McDiarmid A, Erhayiem B, Broadbent D, Dobson L, Garg P . Assessing Myocardial Extracellular Volume by T1 Mapping to Distinguish Hypertrophic Cardiomyopathy From Athlete's Heart. J Am Coll Cardiol. 2016; 67(18):2189-2190. DOI: 10.1016/j.jacc.2016.02.054. View

McDiarmid A, Swoboda P, Erhayiem B, Lancaster R, Lyall G, Broadbent D . Athletic Cardiac Adaptation in Males Is a Consequence of Elevated Myocyte Mass. Circ Cardiovasc Imaging. 2016; 9(4):e003579. PMC: 4841180. DOI: 10.1161/CIRCIMAGING.115.003579. View

Treibel T, Kozor R, Menacho K, Castelletti S, Bulluck H, Rosmini S . Left Ventricular Hypertrophy Revisited: Cell and Matrix Expansion Have Disease-Specific Relationships. Circulation. 2017; 136(25):2519-2521. DOI: 10.1161/CIRCULATIONAHA.117.029895. View

Chin C, Everett R, Kwiecinski J, Vesey A, Yeung E, Esson G . Myocardial Fibrosis and Cardiac Decompensation in Aortic Stenosis. JACC Cardiovasc Imaging. 2016; 10(11):1320-1333. PMC: 5683736. DOI: 10.1016/j.jcmg.2016.10.007. View

Woodiwiss A, Oosthuyse T, Norton G . Reduced cardiac stiffness following exercise is associated with preserved myocardial collagen characteristics in the rat. Eur J Appl Physiol Occup Physiol. 1998; 78(2):148-54. DOI: 10.1007/s004210050400. View

Maron B, Pelliccia A . The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006; 114(15):1633-44. DOI: 10.1161/CIRCULATIONAHA.106.613562. View

Moon J, Reed E, Sheppard M, Elkington A, Ho S, Burke M . The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2004; 43(12):2260-4. DOI: 10.1016/j.jacc.2004.03.035. View

Flett A, Hayward M, Ashworth M, Hansen M, Taylor A, Elliott P . Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation. 2010; 122(2):138-44. DOI: 10.1161/CIRCULATIONAHA.109.930636. View

Armstrong A, Gidding S, Gjesdal O, Wu C, Bluemke D, Lima J . LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging. 2012; 5(8):837-48. PMC: 3501209. DOI: 10.1016/j.jcmg.2012.06.003. View

10.

DeLong E, Delong D, Clarke-Pearson D . Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3):837-45. View

11.

Arbab-Zadeh A, Perhonen M, Howden E, Peshock R, Zhang R, Adams-Huet B . Cardiac remodeling in response to 1 year of intensive endurance training. Circulation. 2014; 130(24):2152-61. PMC: 5698012. DOI: 10.1161/CIRCULATIONAHA.114.010775. View

12.

Pelliccia A, Maron B, Spataro A, Proschan M, Spirito P . The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991; 324(5):295-301. DOI: 10.1056/NEJM199101313240504. View

13.

Perhonen M, Franco F, Lane L, Buckey J, Blomqvist C, Zerwekh J . Cardiac atrophy after bed rest and spaceflight. J Appl Physiol (1985). 2001; 91(2):645-53. DOI: 10.1152/jappl.2001.91.2.645. View

14.

Pedlar C, Brown M, Shave R, Otto J, Drane A, Michaud-Finch J . Cardiovascular response to prescribed detraining among recreational athletes. J Appl Physiol (1985). 2017; 124(4):813-820. DOI: 10.1152/japplphysiol.00911.2017. View

15.

Rocha F, Carmo E, Roque F, Hashimoto N, Rossoni L, Frimm C . Anabolic steroids induce cardiac renin-angiotensin system and impair the beneficial effects of aerobic training in rats. Am J Physiol Heart Circ Physiol. 2007; 293(6):H3575-83. DOI: 10.1152/ajpheart.01251.2006. View

16.

Moon J, Messroghli D, Kellman P, Piechnik S, Robson M, Ugander M . Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson. 2013; 15:92. PMC: 3854458. DOI: 10.1186/1532-429X-15-92. View

17.

Summers R, Martin D, Meck J, Coleman T . Mechanism of spaceflight-induced changes in left ventricular mass. Am J Cardiol. 2005; 95(9):1128-30. DOI: 10.1016/j.amjcard.2005.01.033. View

18.

Iles L, Pfluger H, Phrommintikul A, Cherayath J, Aksit P, Gupta S . Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced T1 mapping. J Am Coll Cardiol. 2008; 52(19):1574-80. DOI: 10.1016/j.jacc.2008.06.049. View

19.

Milliken M, Stray-Gundersen J, Peshock R, Katz J, Mitchell J . Left ventricular mass as determined by magnetic resonance imaging in male endurance athletes. Am J Cardiol. 1988; 62(4):301-5. DOI: 10.1016/0002-9149(88)90228-7. View

20.

Weiner R, Wang F, Berkstresser B, Kim J, Wang T, Lewis G . Regression of "gray zone" exercise-induced concentric left ventricular hypertrophy during prescribed detraining. J Am Coll Cardiol. 2012; 59(22):1992-4. DOI: 10.1016/j.jacc.2012.01.057. View