title: Athletic Cardiac Adaptation in Males Is a Consequence of Elevated Myocyte Mass.
abstract: BACKGROUND
  Cardiac remodeling occurs in response to regular athletic training, and the degree of remodeling is associated with fitness. Understanding the myocardial structural changes in athlete's heart is important to develop tools that differentiate athletic from cardiomyopathic change. We hypothesized that athletic left ventricular hypertrophy is a consequence of increased myocardial cellular rather than extracellular mass as measured by cardiovascular magnetic resonance.
  
  
  RESULTS
  Forty-five males (30 athletes and 15 sedentary age-matched healthy controls) underwent comprehensive cardiovascular magnetic resonance studies, including native and postcontrast T1 mapping for extracellular volume calculation. In addition, the 30 athletes performed a maximal exercise test to assess aerobic capacity and anaerobic threshold. Participants were grouped by athleticism: untrained, low performance, and high performance (O2max <60 or>60 mL/kg per min, respectively). In athletes, indexed cellular mass was greater in high- than low-performance athletes 60.7±7.5 versus 48.6±6.3 g/m(2); P<0.001), whereas extracellular mass was constant (16.3±2.2 versus 15.3±2.2 g/m(2); P=0.20). Indexed left ventricular end-diastolic volume and mass correlated with O2max (r=0.45, P=0.01; r=0.55, P=0.002) and differed significantly by group (P=0.01; P<0.001, respectively). Extracellular volume had an inverse correlation with O2max (r=-0.53, P=0.003 and left ventricular mass index (r=-0.44, P=0.02).
  
  
  CONCLUSIONS
  Increasing left ventricular mass in athlete's heart occurs because of an expansion of the cellular compartment while the extracellular volume becomes relatively smaller: a difference which becomes more marked as left ventricular mass increases. Athletic remodeling, both on a macroscopic and cellular level, is associated with the degree of an individual's fitness. Cardiovascular magnetic resonance ECV quantification may have a future role in differentiating athlete's heart from change secondary to cardiomyopathy.
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Adam K
authors.initials: AK
authors.lastname: McDiarmid
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Swoboda
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Bara
authors.initials: B
authors.lastname: Erhayiem
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Rosalind E
authors.initials: RE
authors.lastname: Lancaster
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Gemma K
authors.initials: GK
authors.lastname: Lyall
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Broadbent
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Dobson
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Tarique A
authors.initials: TA
authors.lastname: Musa
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Ripley
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
authors.forename: Carrie
authors.initials: C
authors.lastname: Ferguson
authors.affiliation: From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK. s.plein@leeds.ac.uk.
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D056352:Athletes; D009202:Cardiomyopathies / Q000175:diagnosis; D016022:Case-Control Studies; D003287:Contrast Media; D005080:Exercise Test; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011446:Prospective Studies
chemical_list: D003287:Contrast Media
keywords: ECV; T1 mapping; athlete’s heart; cardiovascular magnetic resonance imaging; exercise physiology; hypertrophy/remodeling