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☆
Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., Picard, M. H., Roman, M. J., Seward, J. B., & Shanewise, J. S. (2006) · European Journal of Echocardiography · doi:10.1016/j.euje.2005.12.014 · Cited by 3,588
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Marcus, G. M., McKenna, W. J., Sherrill, D., Basso, C., Bauce, B., Bluemke, D. A., Calkins, H. G., Corrado, D., Cox, M. G. P. J., Daubert, J. P., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq025 · Cited by 1,610
Iles, L., Pflüger, H., Phrommintikul, A., Cherayath, J., Ciris, P. A., Gupta, S., Kaye, D. M., & Taylor, A. J. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.06.049 · Cited by 741
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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
Mohlenkamp, S., Lehmann, N., Breuckmann, F., Brocker-Preuss, M., Nassenstein, K., Halle, M., Budde, T., Mann, K., Barkhausen, J., Heusch, G., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn163 · Cited by 487
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 301–400 of 773
Piotrowska, K., Zgutka, K., Tkacz, M., & Tarnowski, M. (2023) · Antioxidants · doi:10.3390/antiox12081488 · Cited by 18
Javed, W., Malhotra, A., & Swoboda, P. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.131382 · Cited by 16
Sudden cardiac death in athletes
Semsarian, C., Sweeting, J., & Ackerman, M. J. (2015) · British Journal of Sports Medicine · doi:10.1136/bjsports-2015-h1218rep · Cited by 16
Optimal Running Dose and Cardiovascular Risk
McMullen, C. W., Harrast, M. A., & Baggish, A. L. (2018) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000491 · Cited by 17
Exercise Training Induces Left- but not Right-sided Cardiac Remodelling in Olympic Rowers
Kleinnibbelink, G., Panhuyzen-Goedkoop, N. M., Hulshof, H. G., van Dijk, A. P. J., George, K., Somauroo, J. D., Oxborough, D., & Thijssen, D. H. J. (2021) · International Journal of Sports Medicine · doi:10.1055/a-1524-2611 · Cited by 15
Odak, M., Douedi, S., Mararenko, A., Alshami, A., Elkherpitawy, I., Douedi, H., Zacks, E. S., & Sealove, B. A. (2022) · Cardiology Research · doi:10.14740/cr1373 · Cited by 15
“These findings were further supported by Teske and Le Gerche et al that also found disproportionate right ventricular remodeling in endurance athletes [28, 29].”
ResultExploratory insights from the right‐sided electrocardiogram following prolonged endurance exercise
Lord, R. N., George, K., Somauroo, J. D., Jain, N., Reese, K., Hoffman, M. D., Haddad, F., Ashley, E. A., Jones, H., & Oxborough, D. (2016) · European Journal of Sport Science · doi:10.1080/17461391.2016.1165292 · Cited by 15
“…enlargement has been reported using transthoracic echocardiography (Oxborough et al., 2010) and studies have also observed RV dilatation (La Gerche et al., 2012; Oxborough et al., 2011) and a reduction in LV end diastolic volume (La Gerche et al., 2012) in recovery from ultra-endurance exercise.”
BackgroundResultPhysical Activity, Endurance Exercise, and Excess—Can One Overdose?
Kim, J. H., & Baggish, A. L. (2016) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-016-0490-6 · Cited by 16
Qasem, M., George, K., Somauroo, J. D., Forsythe, L., Brown, B., & Oxborough, D. (2018) · International journal of cardiac imaging · doi:10.1007/s10554-018-1316-2 · Cited by 15
“It is important to note that any potential mal-adaptation occurs in sporadic cases and may be dependent on long term repeated exposure and insufficient recovery time [41].”
BackgroundFragakis, N., Vicedomini, G., & Pappone, C. (2011) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2011.3.1.15 · Cited by 19
Zaidi, A., & Sharma, S. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv199 · Cited by 15
Leite-Moreira, A. F., Lourenço, A. P., Balligand, J., et al. (2014) · European Journal of Heart Failure · doi:10.1002/ejhf.66 · Cited by 14
Dupont, A., Poussel, M., Hossu, G., et al. (2016) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2016.10.009 · Cited by 14
“Journal of Science and Medicine in Sport, Elsevier, 2016, 20 (6), pp.”
BackgroundKeyhani, D., Tartibian, B., Dabiri, A., & Teixeira, A. M. (2020) · Journal of Aging and Physical Activity · doi:10.1123/japa.2019-0213 · Cited by 14
Mieszkowski, J., Stankiewicz, B., Kochanowicz, A., Niespodziński, B., Borkowska, A., & Antosiewicz, J. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.571220 · Cited by 14
“Unfortunately, deleterious changes, such as heart calcification (La Gerche et al., 2012) and others, in which exercise-induced inflammation plays a role, are observed in some athletes who regularly participate in such sporting events.”
BackgroundVitiello, D., Palacin, F., Poinsard, L., Kirsch, M., Jouini, S., & Billat, V. L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168676 · Cited by 19
Wolff, S., Picco, J. M., Díaz-González, L., Valenzuela, P. L., Gonzalez-Dávila, E., Santos‐Lozano, A., Matile, P., WOLFF, D. A., Boraíta, A., & Lucía, A. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.744393 · Cited by 14
“Some authors have reported acute RV dilation and dysfunction after intense and prolonged exercise (4, 25).”
BackgroundRight Ventricular Cardiomyopathies: A Multidisciplinary Approach to Diagnosis
Limongelli, G., Rea, A., Masarone, D., et al. (2014) · Echocardiography · doi:10.1111/echo.12399 · Cited by 14
“In fact in a recent article of La Gerche et al.(86) 10% of the 40 endurance athletes enrolled in the study shows at CMR LGE localized to interventricular septum.”
BackgroundGülan, U., Saguner, A. M., Akdiş, D., et al. (2019) · Scientific Reports · doi:10.1038/s41598-018-36614-7 · Cited by 14
Handling confounding variables in statistical shape analysis - application to cardiac remodelling
Bernardino, G., Benkarim, O. M., la Garza, M. S., Prat‐González, S., Sepúlveda-Martínez, Á., Crispi, F., Sitges, M., Butakoff, C., Craene, M. D., Bijnens, B. H., et al. (2020) · Medical Image Analysis · doi:10.1016/j.media.2020.101792 · Cited by 13
“13). Although the remodelling is not yet completely understood, researchers have established a strong relationship between cardiopulmonary performance during exercise and cardiac geometry at rest (La Gerche et al., 2012; Scharhag et al., 2002). 2 Methodology The full process to compute the confounder invariant most di…”
BackgroundLeischik, R. (2014) · American Journal of Sports Science · doi:10.11648/j.ajss.20140202.11 · Cited by 13
“This issue is already under discussion [9, 10].”
BackgroundZhou, Z., Zheng, L., Tang, C., Chen, Z., Zhu, R., Peng, X., Wu, X., & Zhu, P. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.565307 · Cited by 13
Athlete’s ECG Made Easy: A Practical Guide to Surviving Everyday Clinical Practice
Fanale, V., Segreti, A., FOSSATI, C., Gioia, G. D., Coletti, F., Crispino, S. P., Picarelli, F., Incalzi, R. A., Papalia, R., Pigozzi, F., et al. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11100303 · Cited by 13
The acute impact of an ultramarathon on right heart: A 12‐lead ECG study
D’Ascenzi, F., Anselmi, F., Ceccon, C., Baccani, B., Sisti, N., Gismondi, A., Sciaccaluga, C., Aprile, F., Fiorentini, C., Graziano, F., et al. (2019) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13597 · Cited by 13
Domain, G., Chouquet, C., Réant, P., Bongard, V., Vedis, T., Rollin, A., Mandel, F., Delasnerie, H., Voglimacci‐Stephanopoli, Q., Mondoly, P., et al. (2021) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeab063 · Cited by 13
Understanding Exercise Capacity: From Elite Athlete to HFpEF
Rowe, S. J., Paratz, E. D., Foulkes, S., Janssens, K., Spencer, L. W., Fahy, L., D’Ambrosio, P., Haykowsky, M. J., & Gerche, A. L. (2023) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2023.08.007 · Cited by 16
Jongman, J. K., Zaidi, A., Muggenthaler, M. M. A., & Sharma, S. (2015) · EP Europace · doi:10.1093/europace/euv063 · Cited by 13
“In contrast, the present study required only one abnormal parameter to define the presence of late potentials, as per the 2010 Task Force Criteria for the diagnosis of ARVC.”
BackgroundResultInfluentialMoving in extreme environments: extreme loading; carriage versus distance
Lucas, S. J. E., Helge, J. W., Schütz, U. H. W., Goldman, R. F., & Cotter, J. D. (2016) · Extreme Physiology & Medicine · doi:10.1186/s13728-016-0047-z · Cited by 13
“Specifically, functional changes appear mostly reversible following 1 or 2 weeks of recovery [128, 129], while structural remodelling of the right ventricle and myocardial fibrosis in the interventricular septum is evident in some ultra-endurance athletes (e.”
BackgroundQasem, M., George, K., Somauroo, J. D., Forsythe, L., Brown, B., & Oxborough, D. (2018) · Journal of Sports Sciences · doi:10.1080/02640414.2018.1499392 · Cited by 13
“Previous studies have reported a reduction in RV ε secondary to an increased RVEDA (Elliott & La Gerche, 2015) whilst others have demonstrated a reduction in basal (Teske et al., 2009a) and apical function (La Gerche et al., 2012a) in athletes with marked RV dilatation.”
BackgroundResultInfluentialBuchan, T. A., Wright, S. P., Esfandiari, S., Fuchs, F. C., Gray, T., Currie, K. D., Sasson, S. M., Sasson, Z., Mak, S. S., & Goodman, J. M. (2018) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00413.2018 · Cited by 15
The relationship between right heart and aerobic capacity in large cohort of young elite athletes
Suzic-Lazić, J., Tadic, M. V., Antić, M., Radovanović, D., Nešić, D., Rakočević, R., & Mazic, S. D. (2019) · International journal of cardiac imaging · doi:10.1007/s10554-019-01575-z · Cited by 13
Smartphone-based intraocular lens microscope
Chandrakanth, P., & Chandrakanth, K. (2020) · Indian Journal of Ophthalmology · doi:10.4103/ijo.ijo_2032_19 · Cited by 13
Arrhythmogenic Cardiomyopathy and Athletes: A Dangerous Relationship
de la Guía-Galipienso, F., Alzaga, K. U., Grazioli, G. C., Quesada-Ocete, F. J., Feliu-Rey, E., Perez, M. V., Quesada-Dorador, A., & Sanchis‐Gomar, F. (2023) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2023.101799 · Cited by 14
Physical Activity and Cardiac Morphologic Adaptations
Pittaras, A. E., Faselis, C. J., Doumas, M. N., Grassos, C. A., & Kokkinos, P. F. (2023) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2405142 · Cited by 19
“These events are the usual pathophysiologic suspects for electrical instability and cardiac complex arrhythmias [68].”
BackgroundRight ventricular performance during acute hypoxic exercise
Forbes, L. M., Bull, T., Lahm, T., et al. (2024) · The Journal of Physiology · doi:10.1113/jp284943 · Cited by 12
“…function across the spectrum of healthy and diseased states (Brener et al., 2021; Edward et al., 2023), from elite athletes (Edward et al., 2022; La Gerche et al., 2012) and healthy controls (Cornwell et al., 2020) to patients with HFpEF (Rommel et al., 2018), HFrEF (Guazzi et al., 2016) as…”
Wang, X., Li, S., Xia, C., Meng, X., Li, Y., Weng, S., Xu, T., Wang, Y., Kong, Y., Lang, X., et al. (2024) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2024.04.005 · Cited by 12
Celeski, M., Segreti, A., Crisci, F., Cricco, R., Piscione, M., Gioia, G. D., Nusca, A., FOSSATI, C., Pigozzi, F., Ussia, G. P., et al. (2024) · Biomolecules · doi:10.3390/biom14121630 · Cited by 13
Molecular Mediators of the Cardiac Benefits of Exercise
Khetarpal, S. A., Li, H., Lerchenmüller, C., Rhee, J., & Rosenzweig, A. (2025) · Circulation Research · doi:10.1161/circresaha.125.325762 · Cited by 14
Atrial fibrillation and the athletic heart
Redpath, C. J., & Backx, P. H. (2014) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000130 · Cited by 12
Increased active phase atrial contraction is related to marathon runner performance
Gabrielli, L., Herrera, S., Briceño, F. A. C., Vega, J., Ocaranza, M. P., Yáñez, F., Fernández, R., Saavedra, R., Sitges, M., Garcı́a, L., et al. (2018) · European Journal of Applied Physiology · doi:10.1007/s00421-018-3927-7 · Cited by 12
Cardiac adaptation to endurance exercise training: Differential impact of swimming and running
Martinez, V., la Garza, M. S., Grazioli, G. C., Roca, E., Brotons, D., & Sitges, M. (2020) · European Journal of Sport Science · doi:10.1080/17461391.2020.1789228 · Cited by 14
“The increase in PAP during effort has been established as a potential mechanism for the acute RV impairment observed after bouts of intense exercise (La Gerche et al., 2012).”
BackgroundLong-Term Training Increases Atrial Fibrillation Sustainability in Standardbred Racehorses
Carstensen, H., Nissen, S. D., Saljic, A., Hesselkilde, E. M., van Hunnik, A., Hohl, M., Sattler, S. M., Fløgstad, C., Hopster-Iversen, C. C. S., Verheule, S., et al. (2023) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-023-10378-6 · Cited by 14
“However, the results are contradicting and substantial atrial fibrotic development in humans is unlikely [22–27].”
ResultPieles, G. E., Szantho, G. V., Rodrigues, J. C. L., Lawton, C. B., Stuart, G., Bucciarelli‐Ducci, C., Turner, M., Williams, C. A., Tulloh, R. M. R., & Hamilton, M. C. K. (2014) · European Journal of Applied Physiology · doi:10.1007/s00421-014-2833-x · Cited by 12
Excessive exercise in endurance athletes: Is atrial fibrillation a possible consequence?
Goodman, J. M., Banks, L., Connelly, K. A., Yan, A. T.-K., Backx, P. H., & Dorian, P. (2018) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2017-0764 · Cited by 13
“…been confirmed directly in athletes (Flannery et al. 2017), although 98 atrial size in athletes is correlated to lifetime hours of exercise (Pelliccia et al. 2010), 99 possibly from acute exercise-induced atrial distension (La Gerche et al. 2012) and 100 elevated LA pressures (Wright et al. 2015).”
BackgroundWundersitz, D. W. T., Williamson, J., Nadurata, V., Nolan, K., Lavie, C. J., & Kingsley, M. (2019) · International Journal of Cardiology · doi:10.1016/j.ijcard.2019.03.016 · Cited by 12
Impact of Vascular Function on Maximum Power Output in Elite Handball Athletes
Bauer, P., Kraushaar, L. E., Most, A. K., Hölscher, S. I. E., Tajmiri-Gondai, S., Dörr, O., Troidl, C., Bauer, T., NEF, H. M., Hamm, C. W., et al. (2019) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2019.1639602 · Cited by 13
“(La Gerche et al., 2012; La Gerche & Heidbuchel, 2014).”
BackgroundBauer, P., Kraushaar, L. E., Hölscher, S. I. E., Tajmiri-Gondai, S., Dörr, O., NEF, H. M., Hamm, C. W., & Most, A. K. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04210-w · Cited by 12
Nogueira‐Ferreira, R., Ferreira, R. M., Padrão, A. I., Oliveira, P. A., Santos, M. F., Kavazis, A. N., Vitorino, R. M. P., & Moreira‐Gonçalves, D. (2019) · Journal of Physiology and Biochemistry · doi:10.1007/s13105-019-00705-4 · Cited by 13
Sareban, M., Perz, T., Macholz, F., et al. (2020) · International journal of cardiac imaging · doi:10.1007/s10554-020-01803-x · Cited by 12
Wegberger, C., Tscharre, M., Haller, P. M., Piacková, E., Vujasin, I., Gomiscek, A., Tentzeris, I., Freynhofer, M. K., Jäger, B., Wojta, J., et al. (2020) · Clinical Research in Cardiology · doi:10.1007/s00392-020-01634-9 · Cited by 14
Athletic Training and Arrhythmogenic Right Ventricular Cardiomyopathy
Coelho, S., Silva, F., Silva, J., & António, N. (2019) · International Journal of Sports Medicine · doi:10.1055/a-0750-5848 · Cited by 12
“Several studies reported that myocardial fibrosis in athletes was mainly confined to the interventricular septum and RV insertion points [3, 28, 30, 56].”
BackgroundArrhythmogenic Right Ventricular Cardiomyopathy
Zorzi, A., & Corrado, D. (2016) · Wiley eBooks · doi:10.1002/9781119046899.ch20 · Cited by 14
Allwood, R. P., Papadakis, M., & Androulakis, E. S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13154536 · Cited by 15
Beale, A. L., Julliard, M., Maziarski, P., Ziltener, J., Burri, H., & Meyer, P. (2018) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2018.06.017 · Cited by 11
Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology
Lander, B. S., Phelan, D. M. J., Martinez, M. W., & Dineen, E. H. (2021) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-021-00934-1 · Cited by 13
Sørensen, E., Myrstad, M., Solberg, M. G., Øie, E., Tveit, A., & Aarønæs, M. (2022) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2022.06.008 · Cited by 11
Coates, A. M., Millar, P. J., & Burr, J. F. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00570.2022 · Cited by 12
Right ventricular remodeling in athletes and in arrhythmogenic cardiomyopathy
Chivulescu, M., Haugaa, K. H., Lie, Ø. H., Edvardsen, T., Ginghină, C., Popescu, B. A., & Jurcut, R. O. (2017) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2017.1416158 · Cited by 11
“independent measure of contractility [7].”
BackgroundThe acute effect of a high-altitude ultra-trail race on ECG features
Zorzi, A., D’Ascenzi, F., Anselmi, F., et al. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487318820203 · Cited by 11
Challenges in high-sensitive troponin assay interpretation for intensive therapy
Vaz, H. A., Guimarães, R. B., & Dutra, Ó. P. (2019) · Revista Brasileira de Terapia Intensiva · doi:10.5935/0103-507x.20190001 · Cited by 11
“However, this finding has not added prognostic information to date.(76) The clinical impact of exercise-induced cTn elevations is still unclear.”
BackgroundRight Ventricular Diastolic Dysfunction after Marathon Run
Lewicka-Potocka, Z., Dąbrowska-Kugacka, A., Lewicka, E., Gałąska, R., Daniłowicz‐Szymanowicz, L., Faran, A., Nabiałek-Trojanowska, I., Kubik, M., Kaleta-Duss, A. M., & Raczak, G. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17155336 · Cited by 11
Exercise and Competitive Sport: Physiology, Adaptations, and Uncertain Long-Term Risks
Gleason, P. T., & Kim, J. H. (2017) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-017-0578-7 · Cited by 13
Flannery, D., & Gerche, A. L. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.10.004 · Cited by 12
Zaidi, A., & Sharma, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht373 · Cited by 11
Coronary Artery Plaque and Cardiotoxicity as a Result of Extreme Endurance Exercise.
McCullough, P. A., & Lavie, C. J. (2014) · Europe PMC (PubMed Central) · Cited by 12
Shi, M., Dong, Z., Zhao, K., He, X., Sun, Y., Ren, J. T., & Ge, W. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1015639 · Cited by 12
“Long-term training and participation in extreme endurance competitions may lead to a transient reduction in cardiac ejection fraction and an increase in myocardial cell damage markers (12).”
BackgroundDifferent Predictors of Right and Left Ventricular Metabolism in Healthy Middle-Aged Men
Heiskanen, M. A., Leskinen, T., Eskelinen, J., HEINONEN, I. H. A., Löyttyniemi, E., Virtanen, K. A., Pärkkä, J. P., Hannukainen, J. C., & Kalliokoski, K. K. (2015) · Frontiers in Physiology · doi:10.3389/fphys.2015.00389 · Cited by 10
“…be more important during the exercise, and that its ejection fraction may be acutely compromised during strenuous endurance exercise most likely due to the relatively greater exercise-induced increase in RV work load (Trivax et al., 2010; La Gerche et al., 2011, 2012; Elliott and La Gerche, 2015).”
BackgroundCalleja-Romero, A., Vicente‐Rodríguez, G., & Garatachea, N. (2021) · Journal of Sports Sciences · doi:10.1080/02640414.2021.1986276 · Cited by 10
“However, there is currently no consensus on the beneficial, neutral, or negative impact of an LDR on some CV variables, such as systolic function, vascular function, or inflammatory markers (Burr et al., 2014; La Gerche et al., 2012; King et al., 2021).”
BackgroundSzelid, Z., Lux, Á., Kolossváry, M., Tóth, A., Vágó, H., Lendvai, Z., Kiss, L. Z., Maurovich‐Horvat, P., Bagyura, Z., & Merkely, B. P. (2015) · PLoS ONE · doi:10.1371/journal.pone.0141680 · Cited by 13
“As sustained right ventricular fatigue and injury may result in pathologic fibrous remodeling, the clinical significance of our findings could lie with their potential influence on the development of RV cardiomyopathy [7,37].”
BackgroundAsoom, L. I. A., Al-Shaikh, B. A., Bamosa, A. O., & El-Bahai, M. N. (2014) · Cardiovascular Toxicology · doi:10.1007/s12012-014-9244-4 · Cited by 12
“These negative results reflect absence of ischemic changes or abnormal currents due to myocardial injury in these models of hypertrophied hearts [4, 28, 29].”
BackgroundRaukar, N. P., Zonfrillo, M. R., Kane, K. E., et al. (2014) · Academic Emergency Medicine · doi:10.1111/acem.12535 · Cited by 10
Effects of Excessive Endurance Activity on the Heart
Seidl, J., & Asplund, C. A. (2014) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000097 · Cited by 10
Rothwell, O. J., George, K., Somauroo, J. D., Lord, R. N., Stembridge, M. R., Shave, R., Hoffman, M. D., Wilson, M. G., Ashley, E. A., Haddad, F., et al. (2018) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2017.11.021 · Cited by 11
“Fibrosis has been documented in highly trained animal models [17], and has previously been observed in a small number of highly trained veteran endurance athletes [41] and often confined to the inter-ventricular septum most frequently in the regions of RV attachment [4,15].”
Background2706 km cycling in 2 weeks: effects on cardiac function in 6 elderly male athletes
Morville, T. H., Rosenkilde, M., Mattsson, N., et al. (2018) · The Physician and Sportsmedicine · doi:10.1080/00913847.2018.1477403 · Cited by 10
The Spectrum of Change in the Elite Athlete's Heart
Perry, R., Swan, A., Hecker, T., et al. (2019) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2019.04.006 · Cited by 10
Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis
Wundersitz, D. W. T., Gordon, B. A., Lavie, C. J., Nadurata, V., & Kingsley, M. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.07.004 · Cited by 11
Bachman, N. P., Terwoord, J. D., Richards, J. C., Braun, B., Green, C. P., Luckasen, G. J., & Dinenno, F. A. (2020) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2020.11.030 · Cited by 11
Lakin, R., Debi, R., Yang, S., Polidovitch, N., Goodman, J. M., & Backx, P. H. (2021) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00603.2020 · Cited by 11
Exercise Training In Athletes With Heart Disease
Fernández, A. B., & Thompson, P. D. (2017) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2017.05.004 · Cited by 10
Cardiac Biomarkers Following Marathon Running: Is Running Time a Factor for Biomarker Change?
Traiperm, N., chaunchaiyakul, R. C., Burtscher, M., & Gatterer, H. (2021) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2020-0352 · Cited by 10
MACEIRA, A., VALENZUELA, P. L., SANTOS-LOZANO, A., GARCÍA-GONZÁLEZ, M. P., ORTEGA, L. H., DÍAZ-GONZALEZ, L., BORAITA, A., BARRANCO-GIL, D., & LUCIA, A. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003043 · Cited by 9
“According to previous research, when present, LGE among long-term endurance athletes is primarily identified in the intraventricular septum and where the right ventricle joins the septum, and may be the result of repeated myocardial microinjury or the expansion of right ventricle (28,32).”
MethodJanik, M., Blachut, D., Czogalik, Ł., Tomasik, A. R., Wojciechowska, C., & Kukulski, T. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26178329 · Cited by 17
“During intense endurance activity, cardiac output may increase up to sevenfold compared to resting values, leading to increased pulmonary circulation pressure and heightened RV wall stress [23,129] (Figure 2).”
InfluentialHistological evaluation of cardiac remodelling in equine athletes
Nath, L. C., Saljic, A., Buhl, R., Elliott, A. D., Gerche, A. L., Ye, C., Royal, H. S., Virklund, K. L., Agbaedeng, T. A., Stent, A. W., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-67621-6 · Cited by 12
Atrial cardiomyopathy in endurance athletes
Spencer, L. W., D’Ambrosio, P., Ohanian, M., Rowe, S. J., Janssens, K., Claessen, G., Fatkin, D., & Gerche, A. L. (2024) · npj Cardiovascular Health · doi:10.1038/s44325-024-00032-8 · Cited by 9
“AcuteexercisehasbeenassociatedwithelevatedconcentrationsofbothcTnandNT-proBNP 79,80 .”
Arrhythmias and structural remodeling in lifelong and retired master endurance athletes
D’Ambrosio, P., Paepe, J. D., Janssens, K., Mitchell, A. M., Rowe, S. J., Spencer, L. W., Puyvelde, T. V., Bogaert, J., Ghekiere, O., Pauwels, R. W. J., et al. (2025) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2025.101043 · Cited by 14
Self-citationYoung athletes' ECG: Incomplete right bundle branch block vs crista supraventricularis pattern
Díaz-González, L., Bruña, V., Velásquez‐Rodríguez, J., et al. (2020) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13763 · Cited by 9
Post-marathon Decline in Right Ventricular Radial Motion Component Among Amateur Sportsmen
Lewicka-Potocka, Z., Kaleta-Duss, A. M., Lewicka, E., Kubik, M., Faran, A., Szymeczko, P., Gałąska, R., Raczak, G., & Dąbrowska-Kugacka, A. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2021.811764 · Cited by 10
Svensson, A., Aneq, M. Å., Ferm‐Widlund, K., Fluur, C., Gréen, A., Rehnberg, M., & Gunnarsson, C. (2016) · Europe PMC (PubMed Central) · Cited by 9
Right ventricular function during pharmacological and exercise stress testing in horses
Decloedt, A., Clercq, D. D., Ven, S., Vera, L., & van Loon, G. (2017) · The Veterinary Journal · doi:10.1016/j.tvjl.2017.08.001 · Cited by 9
Gabrielli, L., Sitges, M., Chiong, M., Jalil, J., Ocaranza, M. P., Llevaneras, S., Herrera, S., Fernandez, R., Saavedra, R., Yáñez, F., et al. (2018) · European Journal of Sport Science · doi:10.1080/17461391.2018.1484174 · Cited by 9
“This phenomenon could be responsible for fibrosis deposited in patches in the myocardium and larges arteries (Figure 1(D)) (La Gerche et al., 2012).”
BackgroundInfluentialArrhythmogenesis of Sports: Myth or Reality?
Fyyaz, S., & Papadakis, M. (2022) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2021.68 · Cited by 12
Palevičiūtė, E., Šimbelytė, T., Eichstaedt, C. A., Benjamin, N., Egenlauf, B., Grünig, E., & Čelutkienė, J. (2022) · Heart Failure Reviews · doi:10.1007/s10741-022-10259-1 · Cited by 9
Prävention kardiovaskulärer Erkrankungen durch Sport und körperliche Aktivität
Wernhart, S., Dinic, M., Preßler, A., & Halle, M. (2015) · Herz · doi:10.1007/s00059-015-4216-4 · Cited by 8
The Role of the Autonomic Nervous System in Cardiovascular Toxicity
Carll, A. P., Farraj, A. K., & Roberts, A. M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.64259-9 · Cited by 9
Clinical presentations of hypertrophic cardiomyopathy and implications for therapy
Díez‐López, C., & Salazar‐Mendiguchía, J. (2018) · Global Cardiology Science and Practice · doi:10.21542/gcsp.2018.19 · Cited by 9
Stadiotti, I., Piacentini, L., Vavassori, C., Chiesa, M., Scopece, A., Guarino, A., Micheli, B., Polvani, G., Colombo, G. I., Pompilio, G., et al. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.00604 · Cited by 9
“Both results are in line with the transcriptome analysis, in which extracellular matrix organization and collagen production genes were found significantly upregulated in the RV. Interestingly, in healthy hearts, exercise triggers RV profibrotic remodeling (La Gerche et al., 2012).”
ResultThe Right Heart: Acute and Chronic Issues
Churchill, T. W., & Baggish, A. L. (2017) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-017-0581-z · Cited by 9
Brotto, A. R., Phillips, D. B., Meah, V. L., Ross, B., Fuhr, D. P., Beaudry, R. I., van Diepen, S., & Stickland, M. K. (2022) · European Journal of Applied Physiology · doi:10.1007/s00421-021-04866-3 · Cited by 8
Eijsvogels, T. M. H., Kim, J. H., Aengevaeren, V. L., D’Ascenzi, F., Churchill, T., Dineen, E. H., la Garza, M. S., Gati, S., Hálasz, G., Haugaa, K. H., et al. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag040 · Cited by 12
Self-citationAcute versus chronic exercise-induced left-ventricular remodeling
Weiner, R. B., & Baggish, A. L. (2014) · Expert Review of Cardiovascular Therapy · doi:10.1586/14779072.2014.970178 · Cited by 8
“Long-term longitudinal studies will also be required to address the recently proposed concept that high volume exercise over long periods of time may facilitate the development of pathologic remodeling [21] and a clinically relevant form of cardiomyopathy characterized by myocardial fibrosis and resultant malignant ar…”
Background
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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