Myocardial Adaptations to Competitive Swim Training.

Purpose: Swim training is performed in the prone or supine position and obligates water immersion, factors that may augment cardiac volume loading more than other endurance sports. At present, prospective data defining the cardiac responses to swim training are lacking. We therefore studied myocardial adaptations among competitive swimmers to establish a causal relationship between swim training and left ventricular (LV) remodeling.

Diagnostic Yield of Customized Exercise Provocation Following Routine Testing.

Clinical guidelines advocate for customization of exercise testing to address patient-specific diagnostic goals, including reproduction of presenting exertional symptoms. However, the diagnostic yield of adding customized exercise testing to graded exercise in patients presenting with exertional complaints has not been rigorously examined and is the focus of this study. Using prospectively collected data, we analyzed the diagnostic yield of customized additional exercise provocation following inconclusive graded exercise test with measurement of gas exchange.

Endurance exercise training attenuates natriuretic peptide release during maximal effort exercise: biochemical correlates of the "athlete's heart".

Endurance exercise training (ET) stimulates eccentric left ventricular hypertrophy (LVH) with left atrial dilation. To date, the biochemical correlates of exercise-induced cardiac remodeling (EICR) remain incompletely understood. Collegiate male rowers ( = 9) were studied with echocardiography and maximal-effort cardiopulmonary exercise testing (MECPET) before and after 90 days of ET intensification.

The Limits of Cardiac Performance: Can Too Much Exercise Damage the Heart?

Routine moderate-intensity physical activity confers numerous cardiovascular benefits and reduces all-cause mortality. However, the health impact of exercise doses that exceed contemporary physical activity guidelines remains incompletely understood, and an emerging body of literature suggests that high levels of exercise may have the capacity to damage the cardiovascular system. This review focuses on the contemporary controversies regarding high-dose exercise and cardiovascular morbidity and mortality.

Blood Pressure and LV Remodeling Among American-Style Football Players.

Objectives: This study sought to determine the relationships among American-style football (ASF) participation, acquired left ventricular (LV) hypertrophy, and LV systolic function as assessed using contemporary echocardiographic parameters.

Background: Participation in ASF has been associated with development of hypertension and LV hypertrophy. To what degree these processes impact LV function is unknown.

Sudden Cardiac Death in Athletes.

There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation.

Exercise-Induced Left Ventricular Remodeling Among Competitive Athletes: A Phasic Phenomenon.

Background: Contemporary understanding of exercise-induced cardiac remodeling is based on cross-sectional data and relatively short duration longitudinal studies. Temporal progression of exercise-induced cardiac remodeling remains incompletely understood.

Methods And Results: A longitudinal repeated-measures study design using 2-dimensional and speckle-tracking echocardiography was used to examine acute augmentation phase (AAP; 90 days) and more extended chronic maintenance phase (39 months) left ventricular (LV) structural and functional adaptations to endurance exercise training among competitive male rowers (n=12; age 18.

Endurance Exercise-Induced Cardiac Remodeling: Not All Sports Are Created Equal.

Background: The term endurance sport (ES) is broadly used to characterize any exercise that requires maintenance of high cardiac output over extended time. However, the relative amount of isotonic (volume) versus isometric (pressure) cardiac stress varies across ES disciplines. To what degree ES-mediated cardiac remodeling varies, as a function of superimposed isometric stress, is uncertain.

Myocardial adaptations to recreational marathon training among middle-aged men.

Background: Myocardial adaptations to exercise have been well documented among competitive athletes. To what degree cardiac remodeling occurs among recreational exercisers is unknown. We sought to evaluate the effect of recreational marathon training on myocardial structure and function comprehensively.

Impact of American-style football participation on vascular function.

Although hypertension is common in American-style football (ASF) players, the presence of concomitant vascular dysfunction has not been previously characterized. We sought to examine the impact of ASF participation on arterial stiffness and to compare metrics of arterial function between collegiate ASF participants and nonathletic collegiate controls. Newly matriculated collegiate athletes were studied longitudinally during a single season of ASF participation and were then compared with healthy undergraduate controls.

ECG findings in competitive rowers: normative data and the prevalence of abnormalities using contemporary screening recommendations.

Background/aim: The international governing body for competitive rowing recently mandated the inclusion of 12-lead ECG during preparticipation screening. We therefore sought to describe normative ECG characteristics and to examine the prevalence of abnormal ECG findings as defined by contemporary athlete ECG interpretation criteria among competitive rowers.

Methods: Competitive rowers (n=330, 56% male) underwent standard 12-lead ECG at the time of collegiate preparticipation screening.

Blood pressure and left ventricular hypertrophy during American-style football participation.

Background: Hypertension, a strong determinant of cardiovascular disease risk, has been documented among elite, professional American-style football (ASF) players. The risk of increased blood pressure (BP) and early adulthood hypertension among the substantially larger population of collegiate ASF athletes is not known.

Methods And Results: We conducted a prospective, longitudinal study to examine BP, the incidence of hypertension, and left ventricular remodeling among collegiate ASF athletes.

The feasibility, diagnostic yield, and learning curve of portable echocardiography for out-of-hospital cardiovascular disease screening.

Background: The reduction in the size of full-capability echocardiographic machines facilitates "out-of-hospital" transthoracic echocardiography (TTE). Data documenting the feasibility, yield, and logistical considerations of out-of-hospital TTE for preparticipation evaluation of athletes are sparse.

Methods: A multiyear study was conducted to examine the role of 12-lead electrocardiography for athlete screening in which TTE was used to document or exclude underlying structural heart disease.

Dabigatran: a review of clinical and pharmacoeconomic evidence.

Dabigatran etexilate is the first commercially available oral direct thrombin inhibitor. A single trial has studied patients at risk for stroke associated with nonvalvular atrial fibrillation; in this trial, dabigatran 150 mg twice a day met the criteria for superiority over warfarin in preventing stroke and systemic embolism while reducing the rate of hemorrhagic stroke with a similar risk of major bleeding. For the treatment of venous thromboembolism, dabigatran 150 mg twice a day had comparable efficacy and safety versus warfarin.

Performance of the 2010 European Society of Cardiology criteria for ECG interpretation in athletes.

Background: The European Society of Cardiology (ESC) recently published revised criteria for ECG interpretation in the athlete.

Objective: To examine the performance of the 2010 ESC ECG criteria in a population of athletes undergoing preparticipation cardiovascular disease screening.

Methods: University athletes (n=508) underwent routine medical history/physical examination and ECG before athletic participation.

Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training.

Background: Inferior lead early repolarization pattern (ERP) recently has been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the nonanterior ERP in competitive athletes.