European Heart Journal Advance Access originally published online on April 10, 2007
European Heart Journal 2007 28(9):1172; doi:10.1093/eurheartj/ehm056
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From altus to parvus: cardiac fatigue in athletes: reply
Cardiac Ultrasound Laboratory Division of Cardiology Department of Medicine
Massachusetts General Hospital and Harvard Medical School
MA
USA
Cardiac Ultrasound Laboratory Division of Cardiology Department of Medicine
Massachusetts General Hospital and Harvard Medical School
55 Fruit Street, VBK 508, Boston MA 02114-2696
USA
Tel: +1 617 7241991, Fax: +1 617 7268383, E-mail address: mjwood{at}partners.org
We would like to thank Professor Erdem Kasikcioglu for his interest in our article. In response to the initial question of why exhaustive physical activity suppresses diastolic function, we believe that exhaustive physical activity does not attenuate only diastolic, but also systolic function as evidenced by a reduction in the tissue-Doppler-derived strain values in both the septal and lateral walls of our volunteers. The mechanism for this reduction is not completely understood, but may involve an increase in plasma nonepinephrine, ventricular wall stress, free-radical production or changes in energy dynamics, and calcium homeostasis.1
In response to the possibility of permanent impairment of ventricular function, while there has been some suggestion of a form of non-fibrotic arrythmogenic right ventricular dysplasia in a highly selected subset of endurance athletes,2 there is little other data to suggest that there are long-term sequelae to recurrent RV injury during endurance sports.3 In fact, many of the participants in our study were veteran marathon runners and in this subset none exhibited any evidence of left or right ventricular function at baseline. Furthermore, while there has been some suggestion of an increased stroke risk in highly active men in the Harvard Alumni Study,4 there is a wealth of data to suggest that there is no increased cardiovascular risk associated with participation in such event.5,6 While we observed a persistent change in diastolic indices, we recognize that such alterations in baseline could also likely represent a period of de-training rather than persistence of dysfunction or stunning. However, until this question is answered with a study, whereby two equivalently trained and matched cohorts, one completing a marathon and one not, are compared, then repeated episode of extreme strenuous activity within a four-week period may be cautioned.
References
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[Abstract/Free Full Text]
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