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The Munich Triathlon Heart Study: Ventricular Function, Myocardial Velocities, and Two-Dimensional Strain in Healthy Children Before and After Endurance Stress

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Abstract

Intense exercise has been shown to have negative effects on systolic and diastolic ventricular function in adults. Very little is known about the normal reaction of the growing heart to endurance stress. For this study, 26 healthy children (18 males) with a mean age of 12.61 years (range, 7.92–16.42 years) took part in an age-adapted triathlon circuit. The athletes were investigated by two-dimensional (2D) echocardiographic/speckle tracking, M-mode, pulse-wave Doppler, color Doppler, and color-coded tissue Doppler at 2–4 weeks before and immediately after the race. After the competition, cardiac output increased, mediated by an increase in heart rate and not by an elevated preload, according the Frank–Starling mechanism. Two-dimensional speckle tracking showed a reduced longitudinal strain in the right and left ventricles and additionally reduced circumferential strain in the left ventricle. The late diastolic inflow velocities were increased in both ventricles, indicating reduced diastolic function due to an impairment of myocardial relaxation. Immediately after endurance exercise, systolic and diastolic functions were attenuated in children and adolescents. In contrast to adult studies, this study could show a heart rate-mediated increase in cardiac output. The sequelae of these alterations are unclear, and the growing heart especially may be more susceptible to myocardial damage caused by intense endurance stress.

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References

  1. Abali G, Tokgozoglu L, Ozcebe OI, Aytemir K, Nazli N (2005) Which Doppler parameters are load independent? A study in normal volunteers after blood donation. J Am Soc Echocardiogr 12:1260–1265

    Google Scholar 

  2. Avabakan C, Akalin F, Mengütav S, Cotuk B, Odabas I, Ozüak A (2006) Athletes heart in prebubertal male swimmers. Cardiol Young 16:61–66

    Article  Google Scholar 

  3. Bellinger AM, Mongillo M, Marks AR (2008) Stressed out: the skeletal muscle ryanodine receptor as a target of stress. J Clin Invest 118:445–453

    Article  PubMed  CAS  Google Scholar 

  4. Burns AT, Connelly KA, La Gerche A, Mooney DJ, Chan J, MacIsaac AI, Prior DL (2007) Effect of heart rate on tissue Doppler measures of diastolic function. Echocardiography 24:697–701

    Article  PubMed  Google Scholar 

  5. Cain B, Meldrum D, Joo K (1998) Human SERCA2a levels correlate inversely with age in senescent human myocardium. J Am Coll Cardiol 32:458–467

    Article  PubMed  CAS  Google Scholar 

  6. Ebashi S (1991) Excitation-contraction coupling and the mechanism of muscle contraction. Annu Rev Physiol 53:1–16

    Article  PubMed  CAS  Google Scholar 

  7. Greenberg N (2002) Doppler-derived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation 105:99

    Article  PubMed  Google Scholar 

  8. Grossman W (1986) Evaluation of systolic and diastolic function of the myocardium. In: Grossman W (ed) Cardiac catheterization and angiography, 3rd edn. Lea & Febiger, Philadelphia, pp 301–319

    Google Scholar 

  9. Hart E, Dawson E, Rasmussen P, George K, Secher NH, Whyte G, Shave R (2006) Beta-adrenergic receptor desensitization in man: insight into post-exercise attenuation of cardiac function. J Physiol 577:717–725

    Article  PubMed  CAS  Google Scholar 

  10. Hasenfuss G (1998) Calcium pump overexpression and myocardial function: implications for gene therapy and myocardial failure. Circ Res 83:966–968

    Article  PubMed  CAS  Google Scholar 

  11. Hatle L (2007) How to diagnose diastolic heart failure: a consensus statement. Eur Heart J 28:2421–2423

    Article  PubMed  Google Scholar 

  12. Hopkins SR, Gavin TP, Siafakas NM, Haseler LJ, Olfert IM, Wagner H, Wagner PD (1998) Effect of prolonged, heavy exercise on pulmonary gas exchange in athletes. J Appl Physiol 85:1523–1532

    PubMed  CAS  Google Scholar 

  13. Joulin O, Marechaux S, Hassoun S, Montaigne D, Lanel D, Neviere R (2009) Cardiac force-frequency relationship and frequency-dependant acceleration of relaxation are impaired in LPS-treated rats. Crit Care 13:R14

    Article  PubMed  Google Scholar 

  14. Klabunde RE (2005) Cardiovascular physiology concepts 2005. Betty Sun (ed). Lippincott Williams & Wilkins, Baltimore

  15. Korinek J, Wang J, Sengupta PP, Miyazaki, Kjaergaard J, McMahon E, Abraham TP, Belohlavek M (2005) Two-dimensional strain: a Doppler-independent ultrasound method for quantification of regional deformation: validation in vivo and in vitro. J Am Soc Echocardiogr 18:1247–1253

    Article  PubMed  Google Scholar 

  16. Koskenvuo JW, Mirsky R, Zhang Y, Angeli FS, Jahn S, Alastalo TP, Schiller N, Boyle AJ, De Marco T, Yeghiazarians Y (2010) A comparison of echocardiography to invasive measurement in the evaluation of pulmonary arterial hypertension in a rat model. Int J Cardiovasc Imaging 26:509–518

    Article  PubMed  Google Scholar 

  17. La Gerche A, Conelly KA, Mooney DJ, Mac Isaac AJ, Prior DL (2008) Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise. Heart 94:860–866

    Article  PubMed  Google Scholar 

  18. Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM, Pignatelli RH, Rychik, Task Force of the Pediatric Council of the American Society of Echocardiography, Pediatric Council of the American Society of Echocardiography (2006) Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Soitey of Echocardiography. J Am Soc Echocardiogr 19:1413–1430

    Article  PubMed  Google Scholar 

  19. Neilan TG, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor PS, Picard MH, Wood MJ (2006) Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation 114:2325–2333

    Article  PubMed  Google Scholar 

  20. Neilan TG, Yoerger DM, Douglas PS, Marshall JE, Halpern EF, Lawlor D (2006) Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 27(9):1079–1084

    Article  PubMed  Google Scholar 

  21. Nottin S, Doucende G, Schuster-Beck I, Tanguy S, Dauzat M, Obert P (2009) Alteration in left ventricular strains and torsional mechanics after ultra-long-duration exercise in athletes. Circ Cardiovasc Imaging 2:323–330

    Article  PubMed  Google Scholar 

  22. Obert P, Stecken F, Courteix D, Lecoq AM, Guenon P (1998) Effect of long-term intensive endurance training on left ventricular structure and diastolic function in prepubertal children. Int J Sports Med 19:149–154

    Article  PubMed  CAS  Google Scholar 

  23. Oxborough D, Shave R, Warburton D, Williams K, Oxborough A, Charlesworth S, Foulds H, Hoffmann MD, Birch K, George K (2011) Dilatation and dysfunction of the right ventricle immediately after ultra-endurance exercise: exploratory insights from conventional two-dimensional and speckle tracking echocardiography. Circ Cardiovasc Imaging 4:253–263

    Article  PubMed  Google Scholar 

  24. Pfaffenberg RS Jr, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB (1993) The association of changes in physical activity level and other lifestyle characteristics with mortality among men. N Engl J Med 328:538–545

    Article  Google Scholar 

  25. Roche SL, Vogel M, Pitkänen O, Grant B, Slorach C, Fackoury C, Stephens D, Smallhorn J, Benson LN, Kantor PF, Redington AN (2011) Isovolumic acceleration at rest and during exercise in children: normal values for the left ventricle and first noninvasive demonstration of exercise-induced force-frequency relationships. J Am Coll Cardiol 57:1100–1107

    Article  PubMed  Google Scholar 

  26. Sutherland G (2004) Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 17:788

    Article  PubMed  Google Scholar 

  27. Teske AJ, Prakken NH, De Boeck BE, Velthuis BK, Mertens EP, Doevendans PA, Cramer M (2009) Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes. Eur Heart J 30:969–977

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre, Lazarettstrasse 36, 80636, Munich, Germany

    Michael Hauser, Kurt Petzuch, Andreas Kühn, Patrick Schön, Julia Elmenhorst & Manfred O. Vogt

  2. Department of Sports and Health Promotion, Technische Universität, Georg-Brauchle-Ring 60/61, 80992, Munich, Germany

    Martin Schönfelder & Renate Oberhoffer

  3. Franz-Schrank Strasse 2, 80638, Munich, Germany

    Michael Hauser

Authors
  1. Michael Hauser
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  2. Kurt Petzuch
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  3. Andreas Kühn
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  4. Patrick Schön
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  5. Julia Elmenhorst
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  6. Martin Schönfelder
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  7. Renate Oberhoffer
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  8. Manfred O. Vogt
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Correspondence to Michael Hauser.

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Hauser, M., Petzuch, K., Kühn, A. et al. The Munich Triathlon Heart Study: Ventricular Function, Myocardial Velocities, and Two-Dimensional Strain in Healthy Children Before and After Endurance Stress. Pediatr Cardiol 34, 576–582 (2013). https://doi.org/10.1007/s00246-012-0500-8

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  • DOI: https://doi.org/10.1007/s00246-012-0500-8

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