Physiologic left ventricular cavity dilatation in elite athletes
Physiologic left ventricular cavity dilatation in elite athletes
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DOI：
10.7326/0003-4819-130-1-199901050-00005
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发表时间：
1999-01-05
影响因子：
39.2
通讯作者：
Maron, BJ
中科院分区：
文献类型：
--
作者：
Pelliccia, A;Culasso, F;Maron, BJ
背景：在一些训练有素的运动员中，绝对左心室腔尺寸可能会显著增加。这提出了关于运动员心脏和扩张型心肌病的鉴别诊断以及可能被取消竞技体育资格的问题。目的：探讨长期高强度运动条件下左心室腔增大的形态学特征和生理限制。设计：在大量训练有素的运动员样本中评估左心室腔的尺寸。地点：意大利罗马体育科学研究所。参与者：1309名意大利优秀运动员（957名男性和352名女性），年龄13至59岁（平均24岁），参加38项不同的运动。测量：超声心动图评估左心室腔尺寸和多变量统计分析的决定因素。结果：左心室舒张末期腔的尺寸变化很大（女性为38 ~ 66 mm[平均，48 mm]，男性为43 ~ 70 mm[平均，55 mm]），大多数参与者在普遍接受的正常范围内（725名运动员小于或等于54 mm[55%]）。根据60毫米的任意临床切点，185名参与者（14%）的左心室腔明显增大。这些运动员的整体左心室收缩功能在正常范围内，没有局部壁面运动异常；参与者在1至12年（平均4.7年）期间没有心脏症状和功能受损。空腔尺寸的主要决定因素是较大的体表面积和参加某些耐力运动（骑自行车、越野滑雪和划独木舟）。结论：在训练有素的运动员样本中，左心室腔尺寸变化很大，但在近15%的参与者中，左心室腔尺寸显著增加到与原发性扩张型心肌病相一致的程度。在没有收缩功能障碍的情况下，这种腔扩张很可能是对高强度运动条件的极端生理适应。运动员心脏这种显著左心室重构的长期后果和意义尚不清楚。
Background: Absolute left ventricular cavity dimension may be substantially increased in some highly trained athletes. This raises questions about the differential diagnosis between athlete's heart and dilated cardiomyopathy as well as possible disqualification from competitive sports.Objective: To evaluate the morphologic characteristics and physiologic limits of left ventricular cavity enlargement associated with intensive, long-term athletic conditioning.Design: Evaluation of left ventricular cavity dimension in a large sample of highly trained athletes.Setting: institute of Sports Science, Rome, Italy.Participants: 1309 elite Italian athletes (957 men and 352 women), 13 to 59 years of age (mean, 24 years), participating in 38 different sports.Measurements: Echocardiographic assessment of left ventricular cavity dimension and multivariate statistical analysis of the determinants.Results: Left ventricular end-diastolic cavity dimensions varied widely (38 to 66 mm [mean, 48 mm] in women and 43 to 70 mm [mean, 55 mm] in men) and was within generally accepted normal limits for most participants (less than or equal to 54 mm in 725 athletes [55%]). According to an arbitrary clinical cut-point of 60 mm, the left ventricular cavity was substantially enlarged in 185 participants (14%). These athletes had global left ventricular systolic function within normal limits and no regional wall-motion abnormalities; participants remained free of cardiac symptoms and impaired performance over 1 to 12 years (mean, 4.7 years). The major determinants of cavity dimension were greater body surface area and participation in certain endurance sports (cycling, cross-country skiing, and canoeing).Conclusions: In a sample of highly trained athletes, left ventricular cavity dimension varied widely but was strikingly increased to a degree compatible with primary dilated cardiomyopathy in almost 15% of participants. In the absence of systolic dysfunction, this cavity dilatation is most likely an extreme physiologic adaptation to intensive athletic conditioning. The long-term consequences and significance of this marked left Ventricular remodeling of the athlete's heart is not known.