cardiac adaptation to exercise chronic
DESCRIPTION
Cardiac Adaptation to Exercise chronic. Morphological Myocardial Vascular. Functional Neural. CRMS. Chronic Cardiac Adaptation to Exercise. Morphological. Myocardial hypertrophy. Coronaries. CRMS. Chronic Cardiac Adaptation to Exercise. Morphological. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/1.jpg)
Cardiac Adaptation to ExerciseCardiac Adaptation to Exercisechronicchronic
MorphologicalMorphological
•MyocardialMyocardial
•VascularVascular
FunctionalFunctional
•NeuralNeural
![Page 2: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/2.jpg)
Myocardial hypertrophyMyocardial hypertrophy
CoronariesCoronaries
MorphologicalMorphological
CRMSCRMS
Chronic Cardiac Chronic Cardiac Adaptation to ExerciseAdaptation to Exercise
![Page 3: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/3.jpg)
Myocardial hypertrophyMyocardial hypertrophy•EccentricEccentric•ConcentricConcentric
Coronaries
MorphologicalMorphological
CRMSCRMS
Chronic Cardiac Chronic Cardiac Adaptation to ExerciseAdaptation to Exercise
![Page 4: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/4.jpg)
Hypertrophia-Hyperplasia
• Hyperplasia constitutes an increase in the number of cells in an organ or tissue, which may then have increased volume.
• Hypertrophy refers to an increase in the size of cells and, with such change, an increase in the size of the organ
![Page 5: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/5.jpg)
Myocardial hypertrophyMyocardial hypertrophy
pressure overloadpressure overload
Due to physical stimuliDue to physical stimuli
volume overloadvolume overload
Due to hormonal chemical stimuliDue to hormonal chemical stimuli
CRMSCRMS
![Page 6: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/6.jpg)
Factors promoting Cardiac hypertrophy Factors promoting Cardiac hypertrophy Mechanical Force
CRMSCRMS
![Page 7: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/7.jpg)
Development of Myocardial Development of Myocardial HypertrophyHypertrophy
Volume OverloadVolume Overload
Increased parietal Increased parietal diastolic stressdiastolic stress
Addition of sarcomer Addition of sarcomer in seriesin series
Increase chamber sizeIncrease chamber size
Eccentric HypertrophyEccentric Hypertrophy
Pressure OverloadPressure Overload
Increased parietal Increased parietal systolic stresssystolic stress
Addition of sarcomerAddition of sarcomer in parallelin parallel
Increase wall thicknessIncrease wall thickness
Concentric HypertrophyConcentric Hypertrophy
Collagen
CRMSCRMS
![Page 8: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/8.jpg)
Effects of pressure/volume overload Effects of pressure/volume overload on cardiac structure and functionon cardiac structure and function
Exercise (Isometric-Isotonic)Exercise (Isometric-Isotonic)
Athletic HeartAthletic Heart
MyociteMyociteHypertrophyHypertrophy
AdeguateAdeguateCapillary densityCapillary density
Overload Volume/pressureOverload Volume/pressure
Cardiac remodellingCardiac remodellingIncrease contrattilityIncrease contrattility
CRMSCRMS
![Page 9: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/9.jpg)
Effects of Training on Left VentricleEffects of Training on Left Ventricle
![Page 10: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/10.jpg)
Adaptation of the Heart to Adaptation of the Heart to Exercise TrainingExercise Training
![Page 11: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/11.jpg)
Adaptation of the Heart to Exercise Adaptation of the Heart to Exercise
ConcentricConcentric EccentricEccentric
NormalNormal
![Page 12: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/12.jpg)
![Page 13: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/13.jpg)
Calculation of Left Ventricle MassCalculation of Left Ventricle Mass
LVM(gr) =0,80x1,05x (IVS+PWT+LVID)3-LVID 3
CRMSCRMS
![Page 14: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/14.jpg)
Anatomical Section Through Anatomical Section Through the Short Axis of Left Ventriclethe Short Axis of Left Ventricle
![Page 15: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/15.jpg)
Short Axis View of Left Ventricle Short Axis View of Left Ventricle in Normal Subjectin Normal Subject
![Page 16: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/16.jpg)
Short Axis View of Left VentricleShort Axis View of Left Ventriclein Athletein Athlete
![Page 17: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/17.jpg)
Pathological HypertrophyPathological Hypertrophy
![Page 18: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/18.jpg)
1.1. AgeAge2.2. GenderGender3.3. Type of stimulusType of stimulus4.4. Genetic heritageGenetic heritage
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
CRMSCRMS
![Page 19: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/19.jpg)
• AgeAge
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
![Page 20: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/20.jpg)
Left Ventricular Mass in young athletes ( soccer players): a cross
echocardiographic study
Giorgio Galanti M.D, Paolo Manetti M.D., Maria Concetta Vono M.D., Loira Toncelli
M.D., Paola Zilli M.D., Carlo Rostagno M.D., Vieri Boddi M.Sc.*, Natale Villari
M.D**,Roberto Salti M.D.
CRMSCRMS
![Page 21: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/21.jpg)
• Purpose Purpose - Regular exercising induces changes in left ventricular - Regular exercising induces changes in left ventricular mass (LVM). While its effects in adults are well known, few data are mass (LVM). While its effects in adults are well known, few data are so far available on those in adolescents. so far available on those in adolescents.
• Methods -Methods - group of 127 young male soccer players (aged group of 127 young male soccer players (aged 13.6±2.1 yr., mean ± standard deviation) was studied. They had been 13.6±2.1 yr., mean ± standard deviation) was studied. They had been regularly playing soccer since they were six years old. Players were regularly playing soccer since they were six years old. Players were age-matched with 70 male sedentary adolescents. LVM was age-matched with 70 male sedentary adolescents. LVM was detected with echocardiography and body composition with detected with echocardiography and body composition with bioelectrical impedance analysis. Pubertal stadiation was evaluated bioelectrical impedance analysis. Pubertal stadiation was evaluated with the Tanner method and skeletal maturation with hand x-ray. with the Tanner method and skeletal maturation with hand x-ray.
![Page 22: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/22.jpg)
Results Results - Skeletal age, Tanner maturation and weight were - Skeletal age, Tanner maturation and weight were comparable in the two groups, while height (p=0.002), fat-free mass comparable in the two groups, while height (p=0.002), fat-free mass
(FFM, p<0.0005) and cellular body mass (p=0.002) were higher in (FFM, p<0.0005) and cellular body mass (p=0.002) were higher in athletes. Players showed increased LVM as compared with controls athletes. Players showed increased LVM as compared with controls (159±49 vs. 137±42 g, p=0.002; confirmed by measures of LVM/body (159±49 vs. 137±42 g, p=0.002; confirmed by measures of LVM/body
surface area: 97±19 g/msurface area: 97±19 g/m22 vs. 87±17 g/m vs. 87±17 g/m22, p<0.0005, respectively). , p<0.0005, respectively). Starting from similar values, LVM progressively increased more in Starting from similar values, LVM progressively increased more in players than in controls after 12 yr. (Tanner 2), reaching statistical players than in controls after 12 yr. (Tanner 2), reaching statistical
significance at 15.4 yr. (Tanner 5). In both athletes and controls LVM significance at 15.4 yr. (Tanner 5). In both athletes and controls LVM was directly correlated with all the anthropometric and was directly correlated with all the anthropometric and
cardiovascular parameters examined (p<0.0005). At multivariate cardiovascular parameters examined (p<0.0005). At multivariate analysis LVM was significantly correlated with skeletal age (b=8.54), analysis LVM was significantly correlated with skeletal age (b=8.54), height (b=1.77) in athletes, and with skeletal age (b=4.83) and FFM height (b=1.77) in athletes, and with skeletal age (b=4.83) and FFM
(b=1.83) in controls. (b=1.83) in controls.
![Page 23: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/23.jpg)
Conclusions
• Our data suggest that exercise induces a Our data suggest that exercise induces a physiological left ventricular physiological left ventricular hypertrophy in sportive population. hypertrophy in sportive population.
• This hypertrophy becomes evident after This hypertrophy becomes evident after sexual maturation was achieved.sexual maturation was achieved.
![Page 24: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/24.jpg)
Type of stimulusType of stimulus
CRMSCRMS
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
![Page 25: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/25.jpg)
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
Circulation Reasearch 2001
![Page 26: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/26.jpg)
Genetic HeritageGenetic Heritage
Hypertrophy Modulating Hypertrophy Modulating FactorsFactors
![Page 27: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/27.jpg)
•42 elite soccer male players (from 17 to 31 years old)
•45 age matched healthy male controls
All were studied with echocardiography and DNA analysis
Studied SubjetsStudied SubjetsAllelic Frequency AnalysisAllelic Frequency Analysis
G.Galanti et al. MSSE Nov:2000
![Page 28: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/28.jpg)
Correlation between Left Ventricular Mass (LVM) and I/D Polimorphysm
Athletes withincreased LVM Genotype
DD + ID 14 5
II 0 3
p<0,05
Athletes withoutincreased LVM
G.Galanti et al. MSSE Nov:2000
![Page 29: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/29.jpg)
CONCLUSIONSCONCLUSIONS
• Increase of left ventricular mass is correlated Increase of left ventricular mass is correlated with I/D polimorphism: The DD athletes had with I/D polimorphism: The DD athletes had shown an increase while the II athletes had a shown an increase while the II athletes had a reduction. reduction.
• Increase of left ventricular mass is not Increase of left ventricular mass is not correlated with A/C polimorphism:correlated with A/C polimorphism:
G.Galanti et al. MSSE Nov:2000G.Galanti et al. MSSE Nov:2000 CRMSCRMS
![Page 30: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/30.jpg)
CRMSCRMS
La scelta dello sport è La scelta dello sport è geneticamente determinata?geneticamente determinata?
Association of angiotensin-converting enzyme gene I/DAssociation of angiotensin-converting enzyme gene I/Dpolymorphism with change in left ventricular mass inpolymorphism with change in left ventricular mass inresponse to physical trainingresponse to physical training
Montgomery H, Clarkson P et alCirculation 1997, 96: 741-747)
![Page 31: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/31.jpg)
Soggetti StudiatiSoggetti Studiati
I soggetti studiati comprendevano I soggetti studiati comprendevano
136136 atleti allenati (età media 24±3.5 atleti allenati (età media 24±3.5
anni) tra i quali 121 erano anni) tra i quali 121 erano calciatoricalciatori
(85 maschi, 36 femmine) e 15 (85 maschi, 36 femmine) e 15
ciclisticiclisti (maschi), confrontati con (maschi), confrontati con
155155 controlli, sedentari, controlli, sedentari,
comparabili per sesso ed età.comparabili per sesso ed età.
CRMSCRMS
![Page 32: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/32.jpg)
RisultatiRisultatifrequenza allelicafrequenza allelica
La distribuzione del genotipo La distribuzione del genotipo
è risultata in accordo con è risultata in accordo con
l'equilibrio di Hardy-Weinberg l'equilibrio di Hardy-Weinberg
e la frequenza allelica è e la frequenza allelica è
risultata comparabile nei due risultata comparabile nei due
gruppi. gruppi.
Non sono state evidenziate Non sono state evidenziate
differenze significative differenze significative
comparando la distribuzione comparando la distribuzione
dei genotipi nei vari tipi di dei genotipi nei vari tipi di
sport.sport.
CRMSCRMS
![Page 33: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/33.jpg)
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
CRMSCRMS
![Page 34: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/34.jpg)
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
![Page 35: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/35.jpg)
Types of Myocardial Types of Myocardial HypertrophyHypertrophy
Normal
Adeguate NonAdeguateAdeguate
![Page 36: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/36.jpg)
Variability of wall thickness in Variability of wall thickness in elite athleteselite athletes
0
50
100
150
200
250
300
8 9 10 11 12 13 14
N° AthlN° Athl
Wall Thickness Wall Thickness mmmm
Pelliccia.NEJM.1991
![Page 37: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/37.jpg)
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
![Page 38: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/38.jpg)
Exercise EchocardiographyExercise Echocardiography
![Page 39: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/39.jpg)
1.1. Increse Ejection fractionIncrese Ejection fraction2.2. Decreased Left Systolic Decreased Left Systolic
Ventricular Volume Ventricular Volume 3.3. No significant modifications of No significant modifications of
Wall Stress Wall Stress
Modifications during Exercise Modifications during Exercise EchocardiographyEchocardiography
CRMSCRMS
![Page 40: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/40.jpg)
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic FunctionNormal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
![Page 41: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/41.jpg)
DIASTOLIC FUNCTION IN DIASTOLIC FUNCTION IN ATHLETESATHLETES
ATHLETES CONTROLS
LVM gr/m2 208±28* 112±21
IVR msec 69±12* 76±11
DT msec 171±72 203±31
Ep cm/sec 84±12* 85±19
Ap cm/sec 41±8* 56±15
Galanti et al, Angiology 1992 4:315-20
![Page 42: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/42.jpg)
• Adeguate HypertrophyAdeguate Hypertrophy
• Normal Systolic FunctionNormal Systolic Function
• Normal Diastolic Function Normal Diastolic Function
• ReversibilityReversibility
Athlete’s HeartAthlete’s HeartDistinguishing normal from abnormalDistinguishing normal from abnormal
CRMSCRMS
![Page 43: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/43.jpg)
Regression of Athlete’s Regression of Athlete’s HypertrophyHypertrophy
0
50
100
150
200
250
LVM(gr) LVID(mm)
ContrAth BeAth Af
G.Galanti et al. Cardiologia 1989
![Page 44: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/44.jpg)
Cardiac Adaptation to ExerciseCardiac Adaptation to Exercisechronicchronic
Myocardial hypertrophy•Eccentric•Concentric
CoronariesCoronaries
MorphologicalMorphological
CRMSCRMS
![Page 45: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/45.jpg)
Coronary Arteries
![Page 46: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/46.jpg)
Left Coronary in AthleteLeft Coronary in Athlete
![Page 47: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/47.jpg)
Rigth Coronary in AthleteRigth Coronary in Athlete
![Page 48: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/48.jpg)
Cardiac Adaptation to ExerciseCardiac Adaptation to Exercisechronicchronic
FunctionalFunctional Heart RateHeart Rate
![Page 49: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/49.jpg)
H.R. b/min
Recovery
Cycloergometer
Cardiovascular Response to Cardiovascular Response to Acute Exercise in trained subjectsAcute Exercise in trained subjects
![Page 50: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/50.jpg)
![Page 51: Cardiac Adaptation to Exercise chronic](https://reader036.vdocuments.us/reader036/viewer/2022062308/56813207550346895d985ad2/html5/thumbnails/51.jpg)