The DOI matches its Crossref record; 51 of the 51 references it cites were found in a registry or an index; 13 of the 33 sources its claims cite were checked for support.
Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes
Open accessAbstract
AIMS: Endurance training may be associated with arrhythmogenic cardiac remodelling of the right ventricle (RV). We examined whether myocardial dysfunction following intense endurance exercise affects the RV more than the left ventricle (LV) and whether cumulative exposure to endurance competition influences cardiac remodelling (including fibrosis) in well-trained athletes. METHODS AND RESULTS: Forty athletes were studied at baseline, immediately following an endurance race (3-11 h duration) and 1-week post-race. Evaluation included cardiac troponin (cTnI), B-type natriuretic peptide, and echocardiography [including three-dimensional volumes, ejection fraction (EF), and systolic strain rate]. Delayed gadolinium enhancement (DGE) on cardiac magnetic resonance imaging (CMR) was assessed as a marker of myocardial fibrosis. Relative to baseline, RV volumes increased and all functional measures decreased post-race, whereas LV volumes reduced and function was preserved. B-type natriuretic peptide (13.1 ± 14.0 vs. 25.4 ± 21.4 ng/L, P = 0.003) and cTnI (0.01 ± .03 vs. 0.14 ± .17 μg/L, P < 0.0001) increased post-race and correlated with reductions in RVEF (r = 0.52, P = 0.001 and r = 0.49, P = 0.002, respectively), but not LVEF. Right ventricular ejection fraction decreased with increasing race duration (r = -0.501, P < 0.0001) and VO(2)max (r = -0.359, P = 0.011). Right ventricular function mostly recovered by 1 week. On CMR, DGE localized to the interventricular septum was identified in 5 of 39 athletes who had greater cumulative exercise exposure and lower RVEF (47.1 ± 5.9 vs. 51.1 ± 3.7%, P = 0.042) than those with normal CMR. CONCLUSION: Intense endurance exercise causes acute dysfunction of the RV, but not the LV. Although short-term recovery appears complete, chronic structural changes and reduced RV function are evident in some of the most practiced athletes, the long-term clinical significance of which warrants further study.
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Written from the paper’s full text.
TL;DR
In 40 well-trained endurance athletes, intense endurance exercise caused acute right ventricular (RV) dysfunction and dilation while left ventricular (LV) function was preserved, with most RV recovery by 1 week. A minority showed septal delayed gadolinium enhancement (DGE) and greater cumulative exercise exposure, suggesting possible chronic RV-predominant remodelling.
Key findings
- Post-race RV volumes increased and all RV functional measures decreased, whereas LV volumes decreased and LV function was preserved; RVEF fell by 9% relative to baseline (P < 0.0001) and mostly recovered by 1 week, except RVSRs remained depressed.
- Post-race BNP (13.1 ± 14.0 vs. 25.4 ± 21.4 ng/L, P = 0.003) and cTnI (0.01 ± 0.03 vs. 0.14 ± 0.17 mg/L, P < 0.0001) increased and correlated with reductions in RVEF (r = 0.52, P = 0.001 and r = 0.49, P = 0.002, respectively), but not LVEF.
- RVEF decreased with increasing race duration (r = −0.501, P < 0.0001) and VO2max (r = −0.359, P = 0.011); race completion time and VO2max independently explained 34% of the variance in ΔRVEF (P = 0.001).
- DGE localized to the interventricular septum in 5 of 39 athletes (12.8%); those athletes had greater cumulative exercise exposure and lower RVEF (47.1 ± 5.9 vs. 51.1 ± 3.7%, P = 0.042) than those with normal CMR.
Methods
- Prospective study of 40 well-trained athletes competing in a marathon, endurance triathlon, alpine cycling race, or ultratriathlon; assessments were at baseline, immediately post-race, and 6–11 days after the race.
- Evaluation included cardiac troponin I, B-type natriuretic peptide, echocardiography (three-dimensional volumes, ejection fraction, systolic strain rate), and cardiac magnetic resonance imaging with delayed gadolinium enhancement for myocardial fibrosis.
- Statistical analysis used paired t-tests, ANOVA, factorial repeated-measures ANOVA, and forward stepwise multivariable analysis; the sample size of 40 was prospectively determined to have 90% power to detect a 10% relative reduction in RVEF.
Limitations
- Stated: DGE within the RV free wall was not assessed because adequate nulling of normal RV free wall myocardium was visualized in only a minority of athletes; athletic remodelling may cause fibrosis to be under-appreciated with relative-enhancement techniques.
- Stated: the cohort was relatively small and underpowered for clinical sequelae; biomarker assessment at a single time point may limit interpretation; conclusions about exercise duration are tempered by confounders such as training levels, exercise modality, race conditions, and motivation.
- Evident from text: the study reports no long-term clinical outcomes, and prognostic implications from other clinical conditions should not be extrapolated to this healthy athletic cohort.
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Claims the paper makes
32 Own result · 15 Own interpretation · 8 Own method · 7 No full text of the sources · 4 Partly supported · 3 Supported so far · 2 Supported · 1 Not checked yet · 1 No basis given · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“However, right ventricular (RV) function may be more profoundly affected by intense endurance exercise 6 -10”
What the sources say
- Not checked — no full text of the sourcecites [6] 2008, Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise, Heart source
- Not checked — no full text of the sourcecites [7] 2010, Acute cardiac effects of marathon running, J Appl Physiol source
- Not checked — no full text of the sourcecites [8] 2009, Relation of biomarkers and cardiac magnetic resonance imaging after marathon running, Am J Cardiol source
- Supportedcites [9] 2006, Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon, Circulation source
The Echocardiography section reports that RV percentage area change decreased after the marathon while LV ejection fraction remained unchanged. It also reports changes in LV diastolic function, so the comparison is clearest for systolic function; the claim’s hedged wording is consistent with these findings. Page numbers are not provided in our copy. (LLM, conf=0.90)
- Supportedcites [10] 1990, Different effects of prolonged exercise on the right and left ventricles, J Am Coll Cardiol source
The paper reports that after the Ironman Triathlon, the filling pattern of the right ventricle, but not the left, was altered (Right and left ventricular diastolic function; page unavailable). Its Conclusions also state that the ventricles responded differently to exercise. These findings support the cautious claim that right ventricular function may be more profoundly affected. (LLM, conf=0.87)
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Every source the paper cites for this claim was checked and supports it.
In the paper
“While this could be interpreted as abnormal enhancement, it is more likely to reflect the limitations in spatial resolution of the technique, a sentiment echoed by a panel of experts who deemed that DGE assessment in the RV free wall was too unreliable to be included in the recent revision of diagnostic criteria for arrhythmogenic RV cardiomyopathy.35”
What the sources say
- Supportedcites [35] 2010, Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria, Circulation source
The citation supports the expert panel’s caution about assessing delayed enhancement in the RV free wall, not the citing authors’ observation about athletes. The Discussion (page unavailable) says RV late enhancement can be difficult to identify because the wall is thin and may be confused with fat; the Results describe revised MRI criteria based on RV size, function, and wall motion rather than late enhancement. (LLM, conf=0.88)
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The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“However, there is also emerging evidence that intense endurance exercise may be associated with an excess in arrhythmic disorders, the mechanisms for which remain unexplained.38 -41”
What the sources say
- Not matchedcites [38] 2008, Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists, Eur Heart J
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [39] 2011, Strenuous endurance exercise: is more better for everyone? Our genes won't tell us, Br J Sports Med source
- Supportedcites [40] 2011, Marathon rat: myocardial remodeling in an animal model of vigorous endurance exercise and implications for humans, Circulation source
The Article (see p. 13) reports a higher prevalence of atrial fibrillation in sportsmen than in the general population and describes potential arrhythmia-producing changes from extreme exercise. It also says there is very little information about the myocardial tissue alterations underlying arrhythmias, consistent with the sentence’s uncertainty about mechanisms. (LLM, conf=0.91)
- Supportedcites [41] 2010, Arrhythmias and sport practice, Heart source
The ‘Atrial arrhythmias and endurance exercise’ section reports an association between endurance sport and atrial fibrillation or flutter, and the Conclusions say athlete’s heart may create a substrate for atrial and ventricular arrhythmias. The ‘Mechanisms of AF and flutter’ section describes proposed mechanisms rather than an established explanation; page numbers are unavailable in our copy. (LLM, conf=0.90)
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Every source the paper cites for this claim was checked and supports it.
In the paper
“Studies focussing on the LV of athletes have failed to provide these mechanistic insights, 4 but recent data have suggested that exercise-induced proarrhythmic substrates may develop in the RV while sparing the LV.12,13,15”
What the sources say
- Supportedcites [12] 2007, Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment, Eur Heart J source
The Patient characteristics section (page unavailable) reports an RV origin or arrhythmogenic substrate in most athletes with ventricular arrhythmias, while LV ejection fraction did not differ between athlete groups. The Discussion and Conclusions (pages unavailable) suggest that endurance exercise could promote RV changes, but explicitly leave that causal role unproven—consistent with the claim’s hedged wording. (LLM, conf=0.88)
- Supportedcites [13] 2003, High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias. Role of an electrophysiologic study in risk stratification, Eur Heart J source
In “Presentation, electrophysiological and morphological findings” (page unavailable), the paper reports frequent RV arrhythmogenic involvement but very little evidence of underlying LV disease in its endurance athletes with ventricular arrhythmias. In “Endurance sports and arrhythmogenic structural RV damage” (page unavailable), it speculates that endurance sports may itself lead to RV structural damage. This supports the citing sentence’s hedged claim, within that studied population. (LLM, conf=0.91)
- Supportedcites [15] 2011, Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training, Circulation source
In “Chamber-Specific Myocardial Fibrosis After Intensive Exercise Training” (page not available), the paper reports RV fibrosis after long-term intensive exercise and says the LV did not appear to be affected. In “Intense Exercise Training and Arrhythmogenic Remodeling” (page not available), it suggests that the fibrosis could contribute to the increased ventricular arrhythmia susceptibility observed in exercise-trained rats. This supports the citing sentence’s hedged claim about a possible RV substrate while sparing the LV. (LLM, conf=0.92)
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- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“The considerable increases in pulmonary pressures demonstrated in trained athletes during intense exercise 29,30,34 suggest a similar physiological stress, albeit only transient.”
What the sources say
- Not checked — no full text of the sourcecites [29] 2011, Disproportionate exercise load and remodeling of the athlete's right ventricle, Med Sci Sports Exerc source
- Not checked — no full text of the sourcecites [30] 2010, Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function during exercise, J Appl Physiol source
- Supportedcites [34] 1999, Range of tricuspid regurgitation velocity at rest and during exercise in normal adult men: implications for the diagnosis of pulmonary hypertension, J Am Coll Cardiol source
The CO section reports that pulmonary artery systolic pressure rose with workload and continued to rise in athletes after 160 watts. The Mechanisms of pressure elevation section also states that the study confirmed higher exercise pressures in athletes than in nonathletes. (LLM, conf=0.92)
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In the paper
“Extending these hypotheses to human populations, Ector et al. 12 demonstrated that RVEF (and not LVEF) was reduced in athletes with complex ventricular arrhythmias when compared with healthy athletes and non-athletes without arrhythmias.”
What the sources say
- Partly supportedcites [12] 2007, Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment, Eur Heart J sourceExperimental — accuracy not yet measured
The RV volumes and EF results report significantly lower RVEF in endurance athletes with ventricular arrhythmias than in athletes without them; the Discussion also describes lower RVEF than in non-athlete controls. Neither section reports an LVEF comparison, so the parenthetical claim that LVEF was not reduced is unsupported by our copy. Page numbers are not supplied. (LLM, conf=0.86)
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and VO 2 max (r ¼ 20.359, P ¼ 0.011).”
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In the paper
“Relative to baseline, RV volumes increased”
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In the paper
“and lower RVEF (47.1 + 5.9 vs. 51.1 + 3.7%, P ¼ 0.042) than those with normal CMR.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“In contrast, all measures of LV function were unchanged.”
plain- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 10
- It may state two separate claims as one. 25
- The quote only partly states this claim. 2
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Benito et al. 15 recently documented that intense endurance exercise promoted RV-specific fibrosis in rats which increased vulnerability to ventricular tachycardia following programmed stimulation.”
What the sources say
- Partly supportedcites [15] 2011, Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training, Circulation sourceExperimental — accuracy not yet measured
The chamber-specific remodeling section reports right-ventricular fibrosis after intensive training, with no observed left-ventricular difference. The ventricular-arrhythmia section reports greater inducibility during programmed stimulation in exercise rats (42% versus 6%). But the discussion says fibrosis *could play a role* in that susceptibility; it does not establish that the fibrosis caused the increase. (LLM, conf=0.87)
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In the paper
“Exercise is a powerful intervention in the prevention and treatment of cardiovascular disease for which compelling evidence exists across a wide range of exercise volumes and intensities, including among competitive athletes.4,26,37”
What the sources say
- Partly supportedcites [4] 2010, Long-term clinical consequences of intense, uninterrupted endurance training in olympic athletes, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
The Conclusions (page not provided) report that prolonged, intense endurance training in young Olympic athletes was not associated with cardiovascular events or deterioration in left ventricular function. That supports a limited point about competitive athletes, but the study enrolled athletes free of cardiovascular disease and does not establish exercise as a prevention or treatment intervention across a wide range of volumes and intensities. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [26] 2010, Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity, Circulation source
- Not matchedcites [37] 1993, Increased life expectancy of world class male athletes, Med Sci Sports Exerc
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“More recently, Wilson et al. 18 observed DGE in 6 of 12 elite veteran athletes but not in 17 young novice athletes or 20 older non-athletes.”
What the sources say
- Partly supportedcites [18] 2011, Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes, J Appl Physiol sourceExperimental — accuracy not yet measured
The Results report LGE in 6 of 12 veteran athletes and none in the 17 young athletes or 20 age-matched controls. But the Methods describe the young athletes as experienced endurance competitors with 11–31 years of training, not novices. The paper calls the imaging finding LGE rather than DGE. (LLM, conf=0.90)
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“all measures of systolic RV function were reduced post-race.”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Also, focal gadolinium enhancement and increased RV remodelling were more prevalent in those athletes with a longer history of competitive sport”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“the occurrence of an early diastolic 'septal bounce' on M-mode echocardiography in 26 of 40 athletes which was not present at baseline”
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In the paper
“Significant correlations were evident between the change in RVEF and post-race troponin (r ¼ 0.494, P ¼ 0.002) and BNP levels (r ¼ 0.518, P ¼ 0.001).”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“those with DGE had 16% greater RVEDV and 25% greater RVESV than those athletes in whom there was no DGE (P ¼ 0.029 and 0.003, respectively).”
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In the paper
“There was no correlation between changes in LVEF and post-race cTnI (r ¼ 20.065, P ¼ 0.702) or BNP (r ¼ 0.250, P ¼ 0.125).”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Race completion time and VO 2 max remained as independent predictors in the multivariable analysis (b ¼ 0.459, P ¼ 0.002 and b ¼ 0.294, P ¼ 0.036, respectively), together explaining 34% of the variance in △RVEF (P ¼ 0.001).”
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In the paper
“athletes who had greater cumulative exercise exposure”
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In the paper
“There was a significant interaction between event type and time point (P-value) with a greater reduction in function in those completing the longest event (ultra-triathlon).”
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In the paper
“Right ventricular volumes increased in the post-race setting while left ventricular volumes decreased resulting in a decrease in right ventricular ejection fraction but not left ventricular ejection fraction.”
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In the paper
“These athletes had been competing in endurance sport for longer and had greater structural remodelling of the RV.”
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In the paper
“In addition, we demonstrate that the acute injury and chronic remodelling of the myocardium both disproportionately affect the RV”
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In the paper
“In all cases, focal DGE was confined to the interventricular septum and commonly at the site of RV attachment.”
- Also stated in: § Conclusion and clinical implications · plain
“Images of five athletes in whom focal delayed gadolinium enhancement (DGE) was identified in the interventricular septum (indicated with arrows) when compared with an athlete with a normal study (top left).”
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- Also stated in: § Conclusion and clinical implications · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Ejection fraction (A), fractional area change (B), and systolic strain rate (C ) decreased in the post-race setting.”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Functional abnormalities were confined to the RV and were largely reversible 1 week following the event.”
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In the paper
“A tolerance of .0.5 was set to avoid collinearity between the five entered variables (race duration, VO 2 max, age, weekly, and career training).”
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In the paper
“Written informed consent was obtained from all subjects and the protocol was approved by the St Vincent's Hospital Human Research Ethics Committee in accordance with the Declaration of Helsinki.”
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In the paper
“Intense endurance exercise causes an acute reduction in RV function that increases with race duration and correlates with increases in biomarkers of myocardial injury.”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“suggesting that repetitive ultra-endurance exercise may lead to more extensive RV change and possible myocardial fibrosis.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All reported values are the average of three repeated measures from separate cardiac cycles.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The sample size of 40 was prospectively determined to have a 90% power of detecting a 10% relative reduction in RVEF averaged across all four endurance events”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Delayed gadolinium enhancement within the RV free wall was not assessed because adequate nulling of normal RV free wall myocardium (the reference against which abnormal enhancement is compared) was visualized in only a minority of athletes.”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Intense endurance exercise causes acute dysfunction of the RV, but not the LV.”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Post-race changes in load, myocardial substrates, and metabolites should confound right ventricular and left ventricular measures similarly.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Intense endurance exercise causes an acute reduction in RV function that increases with race duration”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The four endurance events represent a progressive increase in exercise duration.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To be deemed significant, DGE had to be independently identified by both clinicians and, in addition, mean signal intensities in the region of hyperenhancement were required to be more than two standard deviations (SDs) higher than the mean signal intensity of a region of adjacent myocardium”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Delayed gadolinium enhancement (DGE) was qualitatively assessed by two experienced clinicians after comparing pre-and post-contrast short-axis slices to exclude artefacts.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Greater reductions in RV function occurred in those athletes competing for a longer duration, suggesting that the heart has a finite capacity to maintain the increased work demands of exercise.”
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The four endurance events represent a progressive increase in exercise duration.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, BNP may provide a measure of both acute RV load and the resultant fatigue which occurs when this load is sustained.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“We have previously demonstrated that BNP release during intense exercise is associated with greater relative increases in RV systolic pressures, but not LV pressures.30”
What the sources say
- Not checked — no full text of the sourcecites [30] 2010, Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function during exercise, J Appl Physiol source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“It has been demonstrated that ventricular load increases with exercise intensity and is greater for the RV than the LV, 29”
What the sources say
- Not checked — no full text of the sourcecites [29] 2011, Disproportionate exercise load and remodeling of the athlete's right ventricle, Med Sci Sports Exerc source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
The four endurance events represent a progressive increase in exercise duration.
“The four events were selected to represent a progressive increase in exercise duration”
The paper relies on this without support.
Post-race changes in load, myocardial substrates, and metabolites should confound right ventricular and left ventricular measures similarly.
“Comparisons with the LV are most instructive, given that post-race changes in load, myocardial substrates, and metabolites should confound RV and LV measures similarly.”
The paper relies on this without support.
Athletic training results in relatively uniform cardiac remodelling.
“Secondly, athletic training results in relatively uniform cardiac remodelling and it is possible that cardiac fibrosis may be under-appreciated with current techniques that assess relative enhancement.”
The paper relies on this without support.
Focal delayed gadolinium enhancement on cardiac magnetic resonance indicates myocardial fibrosis.
“However, there remained a significant minority of athletes in whom there was evidence of myocardial fibrosis in the interventricular septum.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Conclusion and clinical implications
“Functional abnormalities were confined to the RV”
§ Interventricular dependence
“Post-race LV diastolic filling was impaired, as evidenced by a decrease in the ratio of early (E) to late (A) transmitral flow (EA ratio 1.84 + 0.35 at baseline vs. 1.34 + 0.35 post-race, P , 0.0001) and an increase in E deceleration time (187 + 29 vs. 212 + 40 ms, P ¼ 0.002)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Correlation between functional and biochemical evidence of myocardial injury
“median 0.018 mg/L”
§ Correlation between functional and biochemical evidence of myocardial injury
“range 0.020-0.99mg/L”
Citations
Cites
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Recommendations for chamber quantification☆
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Neilan, T. G., Januzzi, J. L., Lee-Lewandrowski, E., Ton-Nu, T.-T., Yoerger, D. M., Jassal, D. S., Lewandrowski, K. B., Siegel, A. J., Marshall, J. E., Douglas, P. S., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.647461 · Cited by 519
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Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training
Benito, B., Gay-Jordi, G., Serrano-Mollar, A., Guasch, E., Shi, Y., Tardif, J.-C., Brugada, J., Nattel, S., & Mont, L. (2011) · Circulation · doi:10.1161/circulationaha.110.938282 · Cited by 478
Cited by
Sorted by citations
Items 101–200 of 773
Exercise and Atrial Fibrillation: Prevention or Causation?
Elliott, A. D., Linz, D., Verdicchio, C. V., & Sanders, P. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.04.296 · Cited by 65
Shave, R., & Oxborough, D. (2012) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2012.01.007 · Cited by 68
The impact of repeated marathon running on cardiovascular function in the aging population
Karlstedt, E., Chelvanathan, A., Silva, M. D., Cleverley, K., Kumar, K., Bhullar, N., Lytwyn, M., Bohonis, S., Oomah, S., Nepomuceno, R. G., et al. (2012) · Journal of Cardiovascular Magnetic Resonance · doi:10.1186/1532-429x-14-58 · Cited by 63
D’Ascenzi, F., Pelliccia, A., Valentini, F., Malandrino, A., Natali, B. M., Barbati, R., Focardi, M., Bonifazi, M., & Mondillo, S. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.01.121 · Cited by 62
Cardiac damage in athlete’s heart: When the “supernormal” heart fails!
Carbone, A., D’Andrea, A., Riegler, L., Scarafile, R., Pezzullo, E., Martone, F., America, R., Liccardo, B., Galderisi, M., Bossone, E., et al. (2017) · World Journal of Cardiology · doi:10.4330/wjc.v9.i6.470 · Cited by 67
Zorzi, A., Mastella, G., Cipriani, A., Berton, G., Monte, A. D., Gusella, B., Nese, A., Portolan, L., Sciacca, F., Tikvina, S., et al. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318797396 · Cited by 63
What do we know about the cardiac benefits of exercise?
Wei, X., Liu, X., & Rosenzweig, A. (2014) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2014.12.014 · Cited by 62
“Several studies of elite athletes have also found that prolonged, excessive endurance exercise can be associated with maladaptive cardiac phenotypes including fibrosis [17], adverse left ventricular remodeling [18] and atrial Wei et al.”
BackgroundThe Impact of Triathlon Training and Racing on Athletes’ General Health
Vleck, V. E., Millet, G. P., & Alves, F. B. (2014) · Sports Medicine · doi:10.1007/s40279-014-0244-0 · Cited by 66
“Therefore, abnormal left ventricular function [144] may increase with race distance [135, 143].”
BackgroundExercise-induced arrhythmogenic right ventricular cardiomyopathy: fact or fallacy?
Sharma, S., & Zaidi, A. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr436 · Cited by 60
“The current study by La Gerche et al. revealed transient, reversible RV dysfunction following an ultra-endurance event and may be regarded as another publication to raise the burgeoning speculations that regular participation in intensive endurance exercise may induce arrhythmogenic substrates in some athletes.”
InfluentialDifferentiating Athlete’s Heart From Cardiomyopathies — The Left Side
Brosnan, M. J., & Rakhit, D. J. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.04.297 · Cited by 58
Claessen, G., Bosscher, R. D., Janssens, K., Young, P. E., Dausin, C., Claeys, M., Claus, P., Goetschalckx, K., Bogaert, J. G., Mitchell, A. M., et al. (2024) · Circulation · doi:10.1161/circulationaha.122.063777 · Cited by 61
Self-citationElectrocardiographic Predictors of Cardiovascular Mortality
Mozos, I. M., & Caraba, A. (2015) · Disease Markers · doi:10.1155/2015/727401 · Cited by 57
Smartphones for Cell and Biomolecular Detection
Liu, X., Lin, T.-Y., & Lillehoj, P. B. (2014) · Annals of Biomedical Engineering · doi:10.1007/s10439-014-1055-z · Cited by 56
Gerche, A. L., Roberts, T., & Claessen, G. (2014) · Pulmonary Circulation · doi:10.1086/677355 · Cited by 63
“delayed gadolinium enhancement (DGE) on magnetic resonance studies in 13% and 50% of athletes with a longstanding history of endurance competition.(52,53) These findings could be consistent with the hypothesis that sustained exercise excess results in chronic fibrous remodeling and arrhythmogenicity.”
BackgroundCardiac and renal function in a large cohort of amateur marathon runners
Hewing, B., Schattke, S., Spethmann, S., Sanad, W., Schroeckh, S., Schimke, I., Halleck, F., Peters, H., Brechtel, L. M., Lock, J., et al. (2015) · Cardiovascular Ultrasound · doi:10.1186/s12947-015-0007-6 · Cited by 59
“(CMR) or elevated cardiac biomarkers such as troponin or NT-proBNP after running a marathon [2-7].”
BackgroundCan Intense Endurance Exercise Cause Myocardial Damage and Fibrosis?
Gerche, A. L. (2013) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e318287488a · Cited by 56
“In contrast, a number of recent studies have reported decrements in RV function, which are far more substantive than those observed for the LV (26,37,38,40,50).”
BackgroundInfluentialCornwell, W. K., Tran, T., Cerbin, L. P., Coe, G., Muralidhar, A., Hunter, K. S., Altman, N. L., Ambardekar, A. V., TOMPKINS, C. M., Zipse, M. M., et al. (2020) · The Journal of Physiology · doi:10.1113/jp279759 · Cited by 55
Right Heart Structural and Functional Remodeling in Athletes
D’Andrea, A., Gerche, A. L., Golia, E., Teske, A. J., Bossone, E., Russo, M. G., Calabrò, R., & Baggish, A. L. (2014) · Echocardiography · doi:10.1111/echo.12226 · Cited by 54
Brugger, N., Krause, R., Carlen, F., Rimensberger, C., Hille, R., Steck, H., Wilhelm, M., & Seiler, C. A. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2013.11.032 · Cited by 54
“More recently, the focus of interest has shifted to the left atrium (LA) and the right ventricle (RV) [3], because they are subjected to the same amount of volume overload during exercise training, but are less able to adapt, because of their thin-walled structure.”
BackgroundMartherus, R., Jain, R., Takagi, K., Mendsaikhan, U., Turdi, S., Osińska, H. E., James, J. F., Kramer, K., Purevjav, E., & Towbin, J. A. (2015) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00295.2015 · Cited by 55
The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations
Dores, H., Freitas, A., Malhotra, A., Mendes, M., & Sharma, S. (2015) · Revista Portuguesa de Cardiologia · doi:10.1016/j.repc.2014.07.010 · Cited by 54
“La Gerche et al.20 showed that RV volumes increase after endurance races, whereas LV volumes decrease, resulting in decreased RV but not LV ejection fraction (LVEF).”
BackgroundBjerring, A. W., Landgraff, H. W., Leirstein, S., et al. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318776079 · Cited by 51
Crawling to the Finish Line: Why do Endurance Runners Collapse?
Gibson, A. S. C., de Koning, J. J., Thompson, K., Roberts, W. O., Micklewright, D. P., Raglin, J. S., & Foster, C. (2013) · Sports Medicine · doi:10.1007/s40279-013-0044-y · Cited by 52
Acute, Exercise Dose-Dependent Impairment in Atrial Performance During an Endurance Race
la Garza, M. S., Grazioli, G. C., Bijnens, B. H., Sarvari, S. I., Guasch, E., Pajuelo, C., Brotons, D., Subirats, E., Brugada, R., Roca, E., et al. (2016) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2016.03.016 · Cited by 49
“In line with previous studies (13,15,27), LV systolic function showed no changes after the race in any of the 3 groups, but a decrease in LV filling was documented in medium- and long-distance runners.”
BackgroundResultThe Female Athlete’s Heart: Facts and Fallacies
Colombo, C. S. S. D. S., & Finocchiaro, G. (2018) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-018-0699-7 · Cited by 49
Exercise and Arrhythmogenic Right Ventricular Cardiomyopathy
Prior, D., & Gerche, A. L. (2019) · Heart Lung and Circulation · doi:10.1016/j.hlc.2019.12.007 · Cited by 52
Self-citationShapero, K. S., DeLuca, J. R., Contursi, M. E., Wasfy, M. M., Weiner, R. B., Lewis, G. D., Hutter, A. M., & Baggish, A. L. (2016) · Sports Medicine - Open · doi:10.1186/s40798-016-0053-0 · Cited by 47
“However, the dose response relationship between exercise and CV outcomes remains incompletely understood, and there is mounting evidence that people who engage in high levels of exercise may be surprisingly susceptible to specific forms of heart disease including AF [7], coronary atherosclerosis [6], and myocardial fi…”
BackgroundStrenuous Exercise and Cardiovascular Disease Outcomes
Kim, J. H., & Baggish, A. L. (2017) · Current Atherosclerosis Reports · doi:10.1007/s11883-017-0636-3 · Cited by 49
Exercise‐induced release of troponin
Stavroulakis, G. A., & George, K. (2020) · Clinical Cardiology · doi:10.1002/clc.23337 · Cited by 48
“La Gerche et al12 studied 40 athletes following an ultra- endurance race event and showed that cTnI and B-type natriuretic peptide were increased postrace and correlated with decrements in RV, but not LV function, as estimated by echo and cMRI, yet, these effects were reversible after a week.”
BackgroundSports and Exercise Cardiology in the United States
Lawless, C. E., Olshansky, B., Washington, R., Baggish, A. L., Daniels, C. J., Lawrence, S. M., Sullivan, R. M., Kovacs, R. J., & Bové, A. A. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.12.033 · Cited by 45
Galectin-3 increase in endurance athletes
Hättasch, R., Spethmann, S., de Boer, R. A., Ruifrok, W. P., Schattke, S., Wagner, M., Schroeckh, S., Durmus, T., Schimke, I., Sanad, W., et al. (2014) · European Journal of Preventive Cardiology · doi:10.1177/2047487313492069 · Cited by 46
The developing athlete's heart: a cohort study in young athletes transitioning through adolescence
Bjerring, A. W., Landgraff, H. W., Stokke, T. M., et al. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319862061 · Cited by 46
“While data on the subject are quite sparse, studies on RV GLS in pre-adolescent athletes have generally found greater deformation values than similar studies in adult athletes.(19,20) The dynamics of RV remodelling might well be different in the developing heart, which could help explain both the findings from this st…”
BackgroundResultLeischik, R., Spelsberg, N., Niggemann, H., Dworrak, B., & Tiroch, K. A. (2014) · F1000Research · doi:10.12688/f1000research.4001.1 · Cited by 44
Endurance Exercise and the Heart: Friend or Foe?
Sanchis‐Gomar, F., Pérez, L. M., Joyner, M. J., Löllgen, H., & Lucía, A. (2015) · Sports Medicine · doi:10.1007/s40279-015-0434-4 · Cited by 45
Cardiovascular magnetic resonance with parametric mapping in long-term ultra-marathon runners
Małek, Ł. A., Barczuk‐Falęcka, M., Werys, K., Czajkowska, A., Mróz, A., Witek, K., Burrage, M. K., Bakalarski, W., Nowicki, D., Roik, D., et al. (2019) · European Journal of Radiology · doi:10.1016/j.ejrad.2019.06.001 · Cited by 47
Athlete’s Heart: Diagnostic Challenges and Future Perspectives
Innocentiis, C. D., Ricci, F., Khanji, M. Y., Aung, N., Tana, C., Verrengia, E., Petersen, S. E., & Gallina, S. (2018) · Sports Medicine · doi:10.1007/s40279-018-0985-2 · Cited by 46
Cardiac Phenotypes and Markers of Adverse Outcome in Elite Athletes With Ventricular Arrhythmias
Lie, Ø. H., Klæboe, L. G., Dejgaard, L. A., Skjølsvik, E., Grimsmo, J., Bosse, G., Hopp, E., Edvardsen, T., & Haugaa, K. H. (2020) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2020.07.039 · Cited by 47
Dangardt, F., McKenna, W. J., Lüscher, T. F., & Deanfield, J. E. (2013) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2013.90 · Cited by 45
Sudden cardiac death in athletes
Semsarian, C., Sweeting, J., & Ackerman, M. J. (2015) · BMJ · doi:10.1136/bmj.h1218 · Cited by 47
Competitive Sports and the Heart
Scharhag, J., Löllgen, H., & Kindermann, W. (2013) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2013.0014 · Cited by 46
Richter, M. J., Grimminger, J., Krüger, B., Ghofrani, H. A., Mooren, F. C., Gall, H. J., Pilat, C., & Krüger, K. (2016) · Pulmonary Circulation · doi:10.1086/690553 · Cited by 48
“The stress from extreme and prolonged exercise is suspected to result in RV dysfunction with cardiac injury due to myocardial inflammation, substrate deficiency, and oxidative stress.(15) The occurrence of ventricular arrhythmias in athletes has been associated with mild structural and functional RV abnormalities.”
BackgroundKunutsor, S. K., & Laukkanen, J. A. (2024) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2024.2328644 · Cited by 56
“…with preexisting CVD via the following pathways: (i) arrhythmogenic and pathologic cardiac remodeling including adverse right ventricle remodeling [67]; (ii) elevated levels of cardiac biomarkers such as troponin and B-type natriuretic peptides [96], which are also known cardiovascular risk…”
BackgroundIs Exercise Good for the Right Ventricle? Concepts for Health and Disease
Gerche, A. L., & Claessen, G. (2015) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2015.01.022 · Cited by 46
Mechanisms of atrial fibrillation in athletes: what we know and what we do not know
Guasch, E., Mont, L., & Sitges, M. (2018) · Netherlands Heart Journal · doi:10.1007/s12471-018-1080-x · Cited by 49
“Plasmatic troponin levels were associated with right, but not left, ventricular transient dysfunction after strenuous exercise [63], but a worse out-”
BackgroundTahir, E., Scherz, B., Starekova, J., Muellerleile, K., Fischer, R., Schönnagel, B., Warncke, M. L., Stehning, C., Çavuş, E., Bohnen, S., et al. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319859975 · Cited by 42
Zhang, C.-D., Xu, S., Wang, X.-Y., Tao, L., Zhao, W., & Gao, W. D. (2020) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2020.585692 · Cited by 44
Long-Term Cardiac Remodeling and Arrhythmias in Nonelite Marathon Runners
Wilhelm, M., Roten, L., Tanner, H., Schmid, J., Wilhelm, I., & Saner, H. E. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.02.058 · Cited by 43
Right ventricular function across the spectrum of health and disease
Edward, J. A., Banchs, J. A., Parker, H., & Cornwell, W. K. (2022) · Heart · doi:10.1136/heartjnl-2021-320526 · Cited by 45
Gounder, S. S., Kannan, S., Devadoss, D., Miller, C. J., Whitehead, K. J., Odelberg, S. J., Firpo, M. A., Paine, R., Hoidal, J. R., Abel, E. D., et al. (2012) · PLoS ONE · doi:10.1371/annotation/8690bb36-3c5d-48a6-b3be-39a2b50896e1 · Cited by 40
Acute and Chronic Response to Exercise in Athletes: The “Supernormal Heart”
D’Andrea, A., Formisano, T., Riegler, L., Scarafile, R., America, R., Martone, F., Maio, M. D., Russo, M. G., Bossone, E., Galderisi, M., et al. (2017) · Advances in experimental medicine and biology · doi:10.1007/978-981-10-4307-9_2 · Cited by 40
Exercise and arrhythmic risk in TMEM43 p.S358L arrhythmogenic right ventricular cardiomyopathy
Paulin, F. L., Hodgkinson, K. A., MacLaughlan, S., Stuckless, S. N., Templeton, C., Shah, S., Bremner, H., Roberts, J. D., Young, T., Parfrey, P. S., et al. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.02.028 · Cited by 40
Kim, J. H., & Baggish, A. L. (2015) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2015.11.025 · Cited by 40
O’Keefe, J. H., Lavie, C. J., & Guazzi, M. (2014) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2014.11.004 · Cited by 41
“14 biomarkers of myocardial injury (troponin and BNP), which were proportional to immediate post-race transient reductions in RV systolic function by echocardiography.(29)”
Gabrielli, L., Bijnens, B. H., Brambila, C., Duchateau, N., Marin, J., Sitges-Serra, I., Mont, L., Brugada, J., & Sitges, M. (2016) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12610 · Cited by 38
Differentiating the athlete's heart from hypertrophic cardiomyopathy
Wasfy, M. M., & Weiner, R. B. (2015) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000203 · Cited by 39
“LGE has also been identified in long-time endurance athletes [35,36], and the degree of overlap between the amount and patterns of LGE in HCM patients and athletes has not yet been defined.”
BackgroundPhysical Exercise Is a Potential “Medicine” for Atherosclerosis
Yang, J., Cao, R. Y., Gao, R., Mi, Q., Dai, Q., & Zhu, F. (2017) · Advances in experimental medicine and biology · doi:10.1007/978-981-10-4307-9_15 · Cited by 38
Exercise-induced shift in right ventricular contraction pattern: novel marker of athlete’s heart?
Lakatos, B. K., Kiss, O., Tokodi, M., Tősér, Z., Sydó, N., Merkely, G., Babity, M., Szilágyi, M., Komócsin, Z., Bognár, C., et al. (2018) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00304.2018 · Cited by 39
de Sousa, T. L. W., Ostolin, T. L. V. D. P., Sperandio, E. F., Arantes, R. L., Gagliardi, A. R. D. T., Romiti, M., da Silva, R. P., & Dourado, V. Z. (2019) · PLoS ONE · doi:10.1371/journal.pone.0210216 · Cited by 40
Training for Longevity: The Reverse J-Curve for Exercise.
O’Keefe, E. L., Torres-Acosta, N., O’Keefe, J. H., & Lavie, C. J. (2020) · PubMed Central · Cited by 36
Bosscher, R. D., Dausin, C., Janssens, K., Bogaert, J. G., Elliott, A. D., Ghekiere, O., Heyning, C. M. V. D., Sanders, P., Kalman, J. M., Fatkin, D., et al. (2022) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2022-001309 · Cited by 40
Self-citationStewart, G. M., Yamada, A., Haseler, L. J., Kavanagh, J. J., Koerbin, G., Chan, J. H., & Sabapathy, S. (2015) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00917.2014 · Cited by 39
Molina, C. E., Johnson, D. M., Mehel, H., Spätjens, R. L. H. M. G., Mika, D., Algalarrondo, V., Slimane, Z. H., Lechêne, P., Abi‐Gerges, N., van der Linde, H. J., et al. (2014) · Journal of the American Heart Association · doi:10.1161/jaha.114.000858 · Cited by 37
“Enhanced b-AR responsiveness of the RV results from higher cAMP elevation in the cytoplasm, due to a decreased degradation by PDE3 and PDE4 in the RV compared to the LV. ( J Am Heart Assoc.”
BackgroundInfluentialla Garza, M. S., Rubies, C., Batlle, M., Bijnens, B. H., Mont, L., Sitges, M., & Guasch, E. (2017) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00763.2016 · Cited by 39
Fábián, A., Ujvári, A., Tokodi, M., Lakatos, B. K., Kiss, O., Babity, M., Zámodics, M., Sydó, N., Csulak, E., Vágó, H., et al. (2022) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwac026 · Cited by 37
Foury, F., Hu, J., & Vanderstraeten, S. (2004) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-004-4220-y · Cited by 38
Klinkenberg, L. J. J., Res, P. T., Haenen, G. R. M. M., Bast, A., van Loon, L. J. C., van Dieijen‐Visser, M. P., & Meex, S. J. R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0079280 · Cited by 37
“Finally, a strong correlation has been observed between post-exercise cTn concentrations and short-term right ventricular functional impairment [22].”
BackgroundEndurance Sport and “Cardiac Injury”: A Prospective Study of Recreational Ironman Athletes
Leischik, R., & Spelsberg, N. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph110909082 · Cited by 34
“The idea of exercise- induced cardiac disease was suggested by Heidbüchel [51] and LaGerche [46] but the data are controversial [8,53].”
BackgroundCardiac adaptation in athletes of black ethnicity: differentiating pathology from physiology
Chandra, N., Papadakis, M., & Sharma, S. (2012) · Heart · doi:10.1136/heartjnl-2012-301798 · Cited by 36
“These changes usually resolve within 1 week.(35) However, limited data from 102 subjects have demonstrated chronic RV cavity enlargement with Figure 4 (A) Distribution of left ventricular wall thickness (LVWT) in 300 male black athletes and 300 male white athletes.”
BackgroundGraziano, F., Juhász, V., Brunetti, G., Cipriani, A., Szabó, L. E., Merkely, B. P., Corrado, D., D’Ascenzi, F., Vágó, H., & Zorzi, A. (2022) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd9100347 · Cited by 36
Brosnan, M. J., Claessen, G., Heidbüchel, H., et al. (2015) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2015.03.007 · Cited by 36
Self-citationRow for Your Life: A Century of Mortality Follow-Up of French Olympic Rowers
Antero, J., Desgorces, F.-D., Dor, F., Sedeaud, A., Haïda, A., LeVan, P., & Toussaint, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0113362 · Cited by 39
The role of new echocardiographic techniques in athlete’s heart
D’Andrea, A., Bossone, E., Radmilovic, J., Caso, P., Calabrò, R., Russo, M. G., & Galderisi, M. (2015) · F1000Research · doi:10.12688/f1000research.6745.1 · Cited by 34
Gender influence on the adaptation of atrial performance to training
Sanchis, L., Sanz‐de La Garza, M., Bijnens, B., Giraldeau, G., Grazioli, G., Marin, J., Gabrielli, L., Montserrat, S., & Sitges, M. (2017) · European Journal of Sport Science · doi:10.1080/17461391.2017.1294620 · Cited by 35
“This volume and pressure overload seems to particularly involve the right cavities in terms of chamber dilatation and lower deformation (La Gerche et al., 2012).”
BackgroundResultFactors Influencing the Phenotypic Expression of Hypertrophic Cardiomyopathy in Genetic Carriers
Pérez-Sánchez, I., Romero-Puche, A. J., García-Molina, E., Molina, M. S., López-Ayala, J. M., Muñoz‐Esparza, C., López-Cuenca, D., de la Morena, G., Castro-García, F. J., & Gimeno, J. R. (2017) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2017.06.002 · Cited by 35
“The authors of these guidelines conclude that there is no firm data to support this recommendation and that it is based on what seems to be most reasonable to expert panels.(42) In our series, we found that carriers of sarcomeric mutations from the more intense exercise groups were diagnosed with HCM 7 years earlier t…”
BackgroundGho, J. M. I. H., van Es, R., Stathonikos, N., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0094820 · Cited by 35
“ics or intense endurance exercise [14].”
Exercise‐related severe cardiac events
Vicent, L., Ariza‐Solé, A., González‐Juanatey, J. R., Uribarri, A., Ortiz, J., de Sá, E. L., Sans‐Roselló, J., Querol, C. T., Codina, P., Sousa-Casasnovas, I., et al. (2017) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13037 · Cited by 35
Leischik, R., Dworrak, B., Strauss, M., Horlitz, M., Pareja-Galeano, H., de la Guía-Galipienso, F., Lippi, G., Lavie, C. J., Perez, M. V., & Sanchis‐Gomar, F. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.03.015 · Cited by 36
Intrinsic and Extrinsic Contributors to the Cardiac Benefits of Exercise
Hastings, M. H., Castro, C., Freeman, R., Kadir, A. A., Lerchenmüller, C., Li, H., Rhee, J., Roh, J. D., Roh, K., Singh, A. P., et al. (2023) · JACC Basic to Translational Science · doi:10.1016/j.jacbts.2023.07.011 · Cited by 36
“in longtime athletes in some 82,83 but not all studies, 84,85 suggesting that exercise can promote fi brosis under some conditions, although causality is uncertain given confounders inherent in observational studies.”
BackgroundInter-individual variability in right ventricle adaptation after an endurance race
la Garza, M. S., Grazioli, G. C., Bijnens, B. H., Pajuelo, C., Brotons, D., Subirats, E., Brugada, R., Roca, E., & Sitges, M. (2015) · European Journal of Preventive Cardiology · doi:10.1177/2047487315622298 · Cited by 35
“La Gerche et al.8 evaluated the effect of exercise ‘dose’ in terms of the duration of a competition.”
BackgroundResultInfluentialRegular endurance training in adolescents impacts atrial and ventricular size and function
Rundqvist, L., Engvall, J. E., Faresjö, M., et al. (2016) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jew150 · Cited by 32
Right ventricular function during acute exacerbation of severe equine asthma
Decloedt, A., Borowicz, H., Słowikowska, M., et al. (2017) · Equine Veterinary Journal · doi:10.1111/evj.12675 · Cited by 32
Lord, R. N., Utomi, V., Oxborough, D., Curry, B. A., Brown, M., & George, K. (2018) · European Journal of Applied Physiology · doi:10.1007/s00421-018-3906-z · Cited by 35
Forsythe, L., George, K., & Oxborough, D. (2018) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-018-0677-0 · Cited by 31
Arrhythmogenic Right Ventricular Dysplasia
Calkins, H. G. (2013) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2012.12.002 · Cited by 31
Mechanical Regulation of Protein Translation in the Cardiovascular System
Simpson, L. J., Reader, J. S., & Tzima, E. (2020) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2020.00034 · Cited by 31
“Physiological hypertrophy seen in the athlete’s heart is typically not associated with myocyte damage, although some studies have shown myocardial death during intense exercise as well as fibrosis in long-term endurance athletes (La Gerche et al., 2012; Galderisi et al., 2015).”
BackgroundBosscher, R. D., Dausin, C., Claus, P., Bogaert, J., Dymarkowski, S., Goetschalckx, K., Ghekiere, O., Belmans, A., Heyning, C. M. V. D., Herck, P. V., et al. (2021) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2021-001048 · Cited by 32
Self-citationPavlik, G., Major, Z., Csajági, E., Jeserich, M., & Kneffel, Z. (2013) · Acta Physiologica Hungarica · doi:10.1556/aphysiol.100.2013.1.1 · Cited by 30
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“This cascade appears to be multifactorial, starting with diastolic filling abnormalities of the LV and RV at marathon level (6, 7, 19, 20) or moderate intensity shorter duration exercise (21).”
BackgroundMethodResultInfluentialStewart, G. M., Chan, J. H., Yamada, A., Kavanagh, J. J., Haseler, L. J., Shiino, K., & Sabapathy, S. (2016) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jew128 · Cited by 31
“Exercise-induced increases in RV volume and pressure can induce a similar, parallel impact on the left ventricle following ultra-endurance exercise.(1,4) Reductions in LV strain reported after endurance exercise may therefore predominate in the septal”
BackgroundInfluentialAndroulakis, E. S., & Swoboda, P. (2018) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-018-0679-y · Cited by 28
Cardiovascular Care of Masters Athletes
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Biomarkers of Cardiac Stress and Injury in Athletes: What Do They Mean?
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“(RV) dysfunction and structural remodeling [2].”
BackgroundResultInfluentialTahir, E., Starekova, J., Muellerleile, K., Freiwald, E., von Stritzky, A., Münch, J., Avanesov, M., Weinrich, J. M., Stehning, C., Çavuş, E., et al. (2019) · Circulation Journal · doi:10.1253/circj.cj-18-1388 · Cited by 30
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Metadata
- Authors
- La Gerche, A., Burns, A. T., Mooney, D. J., Inder, W. J., Taylor, A. J., Bogaert, J., MacIsaac, A. I., Heidbüchel, H., & Prior, D. L.
- Affiliations
- St Vincent's Hospital Melbourne (AU)
- The University of Melbourne (AU)
- Baker Heart and Diabetes Institute (AU)
- Universitair Ziekenhuis Leuven (BE)
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-12-06
- Volume
- 33
- Issue
- 8
- Pages
- 998-1006
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2148325692
- Semantic Scholar
- 7d299222e3e0cabc4deedc38d9035410d00d5777
- Cited by
- 776
- References
- 48
- Citations by year
- 2026: 34 · 2025: 41 · 2024: 36 · 2023: 38 · 2022: 62 · 2021: 42 · 2020: 82 · 2019: 48 · 2018: 62 · 2017: 61 · 2016: 64 · 2015: 62 · 2014: 71 · 2013: 38 · 2012: 30
- FWCI
- 28.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Keywords
- endurance athletes, right ventricular dysfunction, cardiac remodeling, myocardial fibrosis, arrhythmogenic cardiomyopathy, endurance exercise, right ventricular ejection fraction, late gadolinium enhancement, cardiac troponin I, brain natriuretic peptide, exercise-induced myocardial injury
- MeSH terms
- Adult, Female, Fibrosis, Humans, Male, Middle Aged, Myocardium, Physical Endurance, Stroke Volume, Biomarkers, Exercise, Ventricular Dysfunction, Right, Magnetic Resonance Angiography, Troponin I, Ventricular Remodeling, Athletes
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