Left ventricular function and mechanics following prolonged endurance exercise: an update and meta-analysis with insight
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INVITED REVIEW
Left ventricular function and mechanics following prolonged endurance exercise: an update and meta-analysis with insights from novel techniques Rachel N. Lord1 · Victor Utomi2 · David L. Oxborough2 · Bryony A. Curry1 · Megan Brown1 · Keith P. George2 Received: 25 January 2018 / Accepted: 26 May 2018 © The Author(s) 2018
Abstract Background The cardiac consequences of undertaking endurance exercise are the topic of recent debate. The purpose of this review is to provide an update on a growing body of literature, focusing on left ventricular (LV) function following prolonged endurance exercise over 2 h in duration which have employed novel techniques, including myocardial speckle tracking, to provide a more comprehensive global and regional assessment of LV mechanics. Methods Prospective studies were filtered independently following a pre-set criteria, resulting in the inclusion of 27 studies in the analyses. A random-effects meta-analysis was used to determine the weighted mean difference and 95% confidence intervals (CI) of LV functional and mechanical data from pre-to-post-exercise. Narrative commentary was also provided where volume of available evidence precluded meta-analysis. Results A significant overall reduction in LV longitudinal strain (Ɛ) n = 22 (− 18 ± 1 to − 17 ± 1%; effect size (d) − 9: − 1 to − 0.5%), strain rate n = 10 (SR; d − 0.9: − 0.1.3 to − 0.5 l/s) and twist n = 5 (11.9 ± 2.2 to 8.7 ± 2.2°, d − 1: − 1.6 to − 0.3°) was observed following strenuous endurance exercise (range 120–1740 min) (P 0.05). Conclusion The meta-analysis and narrative commentary demonstrated that a reduction in LV function and mechanics is evident following prolonged endurance exercise. The mechanism(s) responsible for these changes are complex and likely multi-factorial in nature and may be linked to right and left ventricular interaction. Keywords Left ventricular mechanics · Endurance exercise · Echocardiography Abbreviations A′ Late diastolic myocardial tissue velocity ASR Late diastolic strain rate CI Confidence interval cTn Cardiac troponin DBP Diastolic blood pressure E′ Early diastolic myocardial tissue velocity
Communicated by Michael Lindinger. * Rachel N. Lord [email protected] 1
Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cyncoed Road, Cardiff CF236XD, UK
Research Institure for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, UK
2
E/A Ratio of early to late diastolic transmitral blood flow velocities EDV End diastolic volume EF Ejection fraction EICF Exercise-induced cardiac fatigue ESR Early diastolic strain rate Ɛ Strain HR Heart rate LV Left ventricle RV Right ventricle S′ Systolic myocardial tissue velocity SBP Systolic blood pressure SR Strain rate SSR Systolic strain rate TDI Tissue Doppler imaging WMD Weighted mean difference
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Introduction Prolonged strenuous exercise is growing in popularity (Hoffman 2016). Increased participation
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