title: No evidence of adverse cardiac remodeling in former elite endurance athletes.
abstract: BACKGROUND
  The impact of high exercise loads on a previously healthy heart remains controversial. We examined the consequences of decades of strenuous endurance exercise at the highest competition level on heart dimensions and volumes as well as on serum biomarkers of cardiac fibrosis/remodeling.
  
  
  RESULTS
  We compared echocardiographic measurements and serum biomarkers of cardiac fibrosis/remodeling [troponin I, galectin-3, matrix metallopeptidase-2 and -9, N-terminal pro-brain natriuretic peptide, carboxy-terminal propeptide of type I procollagen, and soluble suppressor of tumorigenicity-2 (sST-2)/interleukin(IL)-1R4] in 53 male athletes [11 former professional ('elite') and 42 amateur-level ('sub-elite') cyclists or runners, aged 40-70years] and 18 aged-matched controls. A subset of 15 subjects (5 controls, 3 sub-elite and 7 elite athletes) also underwent cardiac magnetic resonance imaging (cMRI). Elite and sub-elite athletes had greater echocardiography-determined left ventricular myocardial mass indexed to body surface area than controls (113±22, 115.2±23.1 and 94.8±21g/m(2), respectively, p=0.008 for group effect), with similar results for left (50.5±4.4, 48.2±4.3 and 46.4±5.2mm, p=0.008) and right (38.6±3.8, 41.1±5.5 and 34.7±4.3mm, p<0.001) ventricular end-diastolic diameter, and cMRI-determined left atrial volume indexed to body surface area (62.7±8.1, 56.4±16.0 and 39.0±14.1ml/m(2), p=0.026). Two athletes showed a non-coronary pattern of small, fibrotic left ventricular patches detected by late gadolinium enhancement. No group effect was noted for biomarkers.
  
  
  CONCLUSIONS
  Regardless of their competition level at a younger age, veteran endurance athletes showed an overall healthy, non-pathological pattern of cardiac remodeling. Nonetheless, the physiopathology of the ventricular fibrotic patches detected warrants further investigation.
authors: Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain. Electronic address: fabian.sanchis@uv.es.
authors: Fabian
authors: F
authors: Sanchis-Gomar
authors: Cardiology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors: Marta
authors: M
authors: López-Ramón
authors: Research Institute "Dr. Viña Giner", Molecular and Mitochondrial Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors: Rafael
authors: R
authors: Alis
authors: Faculty of Health and Sport Science, University of Zaragoza, Huesca, Spain.
authors: Nuria
authors: N
authors: Garatachea
authors: European University of Madrid, Madrid, Spain.
authors: Helios
authors: H
authors: Pareja-Galeano
authors: Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain; GIDFYS, European University Miguel de Cervantes, Valladolid, Spain.
authors: Alejandro
authors: A
authors: Santos-Lozano
authors: Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors: Pilar
authors: P
authors: Catalán
authors: Laboratory of Experimental Biochemistry & Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milano, Italy.
authors: Veronica
authors: V
authors: Sansoni
authors: Laboratory of Experimental Biochemistry & Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milano, Italy.
authors: Silvia
authors: S
authors: Perego
authors: Laboratory of Experimental Biochemistry & Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milano, Italy.
authors: Giovanni
authors: G
authors: Lombardi
authors: EFSMA and German Fed, Sports Medicine, Remscheid, Germany.
authors: Herbert
authors: H
authors: Löllgen
authors: Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain; Cardiology Department. Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
authors: Hector
authors: H
authors: Bueno
authors: Faculty of Medicine, Physical Education and Sports Section, University of Zaragoza, Zaragoza, Spain.
authors: Enrique
authors: E
authors: Serrano-Ostáriz
authors: Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain; European University of Madrid, Madrid, Spain.
authors: Alejandro
authors: A
authors: Lucia
mesh_terms: D000328:Adult; D056352:Athletes; D004452:Echocardiography / Q000379:methods; D015444:Exercise / Q000502:physiology*; D006334:Heart Function Tests / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010807:Physical Endurance / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology*; D012016:Reference Values; D013177:Sports / Q000502:physiology*; D013995:Time; D016276:Ventricular Function / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology
keywords: Cardiac fibrosis; Cardiac remodeling; Endurance exercise