title: Exercise-Induced Left Ventricular Remodeling Among Competitive Athletes: A Phasic Phenomenon.
abstract: BACKGROUND
  Contemporary understanding of exercise-induced cardiac remodeling is based on cross-sectional data and relatively short duration longitudinal studies. Temporal progression of exercise-induced cardiac remodeling remains incompletely understood.
  
  
  RESULTS
  A longitudinal repeated-measures study design using 2-dimensional and speckle-tracking echocardiography was used to examine acute augmentation phase (AAP; 90 days) and more extended chronic maintenance phase (39 months) left ventricular (LV) structural and functional adaptations to endurance exercise training among competitive male rowers (n=12; age 18.6±0.5 years). LV mass was within normal limits at baseline (93±9 g/m(2)), increased after AAP (105±7 g/m(2); P=0.001), and further increased after chronic maintenance phase (113±10 g/m(2); P<0.001 for comparison to post-AAP). AAP LV hypertrophy was driven by LV dilation (ΔLV end-diastolic volume, 9±3 mL/m(2); P=0.004) with stable LV wall thickness (ΔLV wall thickness, 0.3±0.1 mm; P=0.63). In contrast, chronic maintenance phase LV hypertrophy was attributable to LV wall thickening (Δ LV wall thickness, 1.1±0.4 mm; P=0.004) with stable LV chamber volumes (ΔLV end-diastolic volume, 1±1 mL/m(2); P=0.48). Early diastolic peak tissue velocity increased during AAP (-11.7±1.9 versus -13.6±1.3 cm/s; P<0.001) and remained similarly increased after chronic maintenance phase.
  
  
  CONCLUSIONS
  In a small sample of competitive endurance athletes, exercise-induced cardiac remodeling follows a phasic response with increases in LV chamber size, early diastolic function, and systolic twist in an acute augmentation phase of exercise training. This is followed by a chronic phase of adaptation characterized by increasing wall thickness and regression in LV twist. Training duration is a determinant of exercise-induced cardiac remodeling and has implications for the assessment of myocardial structure and function in athletes.
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.). rweiner@partners.org.
authors.forename: Rory B
authors.initials: RB
authors.lastname: Weiner
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: James R
authors.initials: JR
authors.lastname: DeLuca
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Francis
authors.initials: F
authors.lastname: Wang
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lin
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Meagan M
authors.initials: MM
authors.lastname: Wasfy
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Brant
authors.initials: B
authors.lastname: Berkstresser
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Eric
authors.initials: E
authors.lastname: Stöhr
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Rob
authors.initials: R
authors.lastname: Shave
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Lewis
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Adolph M
authors.initials: AM
authors.lastname: Hutter
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.affiliation: From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.).
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D001696:Biomechanical Phenomena; D059267:Cardiomegaly, Exercise-Induced; D003163:Competitive Behavior; D018450:Disease Progression; D015150:Echocardiography, Doppler; D015444:Exercise; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D009200:Myocardial Contraction; D010807:Physical Endurance; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult
keywords: echocardiography; exercise; hypertrophy, left ventricular; longitudinal studies; myocardium