title: Exercise-induced arterial hypertension - an independent factor for hypertrophy and a ticking clock for cardiac fatigue or atrial fibrillation in athletes?
abstract: Background : Exercise-induced arterial hypertension (EIAH) leads to myocardial hypertrophy and is associated with a poor prognosis. EIAH might be related to the "cardiac fatigue" caused by endurance training. The goal of this study was to examine whether there is any relationship between EIAH and left ventricular hypertrophy in Ironman-triathletes.
  
  
  METHODS
  We used echocardiography and spiroergometry to determine the left ventricular mass (LVM), the aerobic/anaerobic thresholds and the steady-state blood pressure of 51 healthy male triathletes. The main inclusion criterion was the participation in at least one middle or long distance triathlon.
  
  
  RESULTS
  When comparing triathletes with LVM <220g  and athletes with LVM >220g there was a significant difference between blood pressure values (BP) at the anaerobic threshold (185.2± 21.5 mmHg vs. 198.8 ±22.3 mmHg, p=0.037). The spiroergometric results were: maximum oxygen uptake (relative VO 2max) 57.3 ±7.5ml/min/kg vs. 59.8±9.5ml/min/kg (p=ns). Cut-point analysis for the relationship of BP >170 mmHg at the aerobic threshold and the probability of LVM >220g showed a sensitivity of 95.8%, a specificity of 33.3%, with a positive predictive value of 56.8 %, a good negative predictive value of 90%. The probability of LVM >220g increased with higher BP during exercise (OR: 1.027, 95% CI 1.002-1.052, p= 0.034) or with higher training volume (OR: 1.23, 95% CI 1.04 -1.47, p = 0.019). Echocardiography showed predominantly concentric remodelling, followed by concentric hypertrophy.
  
  
  CONCLUSIONS
  Significant left ventricular hypertrophy with LVM >220g is associated with higher arterial blood pressure at the aerobic or anaerobic threshold. The endurance athletes with EIAH may require a therapeutic intervention to at least prevent extensive stiffening of the heart muscle and exercise-induced cardiac fatigue.
authors.affiliation: Department of Cardiology, Section of Prevention, Health Promotion and Sports Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Hagen, 58095, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Leischik
authors.affiliation: Department of Cardiology, Section of Prevention, Health Promotion and Sports Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Hagen, 58095, Germany.
authors.forename: Norman
authors.initials: N
authors.lastname: Spelsberg
authors.affiliation: Department of Cardiology, Section of Prevention, Health Promotion and Sports Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Hagen, 58095, Germany.
authors.forename: Hiltrud
authors.initials: H
authors.lastname: Niggemann
authors.affiliation: Department of Cardiology, Section of Prevention, Health Promotion and Sports Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Hagen, 58095, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Dworrak
authors.affiliation: Department of Cardiology, Faculty of Health, School of Medicine, Witten/Herdecke University, Helios Hospital Wuppertal, 42117, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiroch