Mature Athletes

Abstract

Objectives

Increasing age is accompanied by a higher risk of sports-related death, especially from coronary disease and cardiomyopathies. It is unclear if the mature athlete’s heart differs from young athletes. Our aim was to assess the effect of age on ventricular volumes and wall-mass. We also established maximum cardiac MRI (CMR) reference values in mature athletes to facilitate differentiation from cardiomyopathy.

Methods

143 healthy persons aged 40-60 years (mean age 49±6 years [±SD], 39% women) underwent CMR: 78 athletes (exercising 9-18 h/week), and 65 age and gender matched non-athletes (≤3 h/week). From a larger study, cardiac MRI data of 195 healthy persons aged 18-39 years (mean age 28±6, 48% women) were included for statistical analysis: 81 athletes and 114 matched non-athletes.

Results

With multivariate analysis, age only has limited effect on ventricular volumes (LV 1%, RV 3%) and wall-mass (0.01%). Only athletes show significant decrease in right and left ventricular volumes and LV-mass with increasing age (p<0.05). RV wall-mass remains unaffected by age. Ventricular diameters, volumes and wall-mass are significantly lower in mature athletes compared to young athletes, and significantly higher compared to mature non-athlete controls (p<0.05).

Conclusions

Only athletes show a significant decrease in ventricular volumes and LV wall-mass with increasing age, which probably reflects decreasing training intensity rather than the effect of age. Mature athletes form a distinct group requiring separate reference values as they have significantly lower ventricular volumes and wall-mass as compared to young athletes, however, still significantly higher values than mature non-athletes.

Baseline characteristics of the study population

	Young men		Mature men		Young Woman		Mature Woman
	Non-athletes	Athletes^a	Non-athletes	Athletes^a	Non-athletes	Athletes^a	Non-athletes	Athletes^a
n	56	45	32	55	58	36	33	23
Age (years)	26 ±5.2	31 ±5.0^b	47 ±6.6	50 ±6.6	26 ±5.9	28 ±4.6	48 ±5.2	50 ±6.5
Height (cm)	183 ± 7.1	184 ±6.7	185 ±8.7	180 ±6.4^c	172 ±5.6	173 ±5.1	169 ±7.4	170 ±5.4
Weight (kg)	78 ± 8.7	78 ±7.8	86 ±12	75 ±8.1^b	63 ±7.7	64 ±6.1	66 ±6.5	61 ±7.5^d
BSA (m²)	2.0 ± 0.1	2.0 ±0.1	2.1 ±0.2	1.9 ±0.1^c	1.7 ±0.1	1.8 ±0.1	1.8 ±0.1	1.7 ±0.1
Systolic BP (mmHg)	128 ±11	133 ±12^d	136 ±21	137 ±16	121 ±12	117 ±12	133 ±19	129 ±17
Diastolic BP (mmHg)	76 ±9.4	76 ±8.5	81 ±10	83 ±9.3	73 ±8.0	69 ±9.1	80 ±11	75 ±10
Mean heart rate (bpm)	66 ±12	56 ±7.9^b	62 ±8.9	57 ±10^d	67 ±9.8	54 ±7.0^b	63 ±8.5	57 ±9.0^d
Training-hours/week	1.8 ±1.3	13 ±2.5^b	1.8 ±1.4	13 ±2.9 b	1.9 ±1.2	13 ±2.4^b	2.2 ±1.2	10 ±1.8^b

Data are expressed as mean±SD. BSA = body surface area; BP = blood pressure; bpm = beats per minute.
^a p-values for significant differences between controls and regular athletes.
^b pb0.0005.
^c pb0.005.
^d pb0.05.

Body surface area corrected ventricular volumes and wall-mass in the mature (aged 39 to 60 years)

Short-axis	Men		Woman
	Non-athletes	Athletes^a	Non-athletes	Athletes^a
n	32	55	33	23
RV
EDV	107±15 (137)	128±19 (160)^b	91 ±12 (112)	104±12 (127)^b
ESV	49±11 (68)	62±13 (83)^b	38±9.8 (56)	47±9.1 (63)^c
Wall-mass	11±1.6 (15)	15±3.3 (21)^b	10±1.2 (12)	13±2.6 (20)^b
EF	55±6.3 (65)	52±4.8 (60)^d	59±6.8 (74)	55±5.8 (69)^d
LV
EDV	98±12 (117)	117±16 (143)^b	88±11 (110)	98±9.7 (123)^b
ESV	40±8.3 (55)	50±10 (68)^b	34±8.8 (52)	41±6.7 (57)^c
Mass	48±8.0 (64)	56±11 (76)^c	36±6.6 (46)	40±6.9 (56)^d
EF	59±6.5 (72)	57±5.2 (66)	62±6.9 (75)	58±4.7 (72)

Data are expressed as mean±SD (95^th percentile), RV, LV = right and left ventricle,
EDV, ESV=end-diastolic and end-systolic volume (mL/m2), wall-mass=end-diastolic
wall-mass (g/m²), EF = ejection fraction (%).
^a p-values for significant differences between controls and regular athletes.
^b pb0.0005.
^c pb0.005.
^d pb0.05.

Absolute and body surface area corrected ventricular diameters and wall thickness in the mature

Short-axis	Men		Woman
	Non-athletes	Athletes^a	Non-athletes	Athletes^a
n	32	55	33	23
Absolute values
RVD sa	47±4.6 (56)	47±6.4 (59)	42±5.0 (52)	44±3.5 (50)
LVD sa	55±4.5 (63)	57±3.4 (62)	51±3.1 (57)	53±3.6 (59)
IVSmax sa	11±1.7 (15)	11±1.7 (14)	8.5±1.4 (11)	9.0±1.1 (12)
RVD la	47±6.6 (57)	51±8.2 (63)	45±5.4 (56)	49±3.9 (56)^b
LVD la	57±4.9 (65)	58±4.1 (65)	52±3.0 (56)	54±3.2 (59)
IVSmax la	11±2.1 (15)	11±1.5 (14)	8.8±1.3 (11)	9.0±1.2 (12)
BSA corrected values
RVD sa/m²	23±3.0 (29)	24±3.4 (30)^b	24±3.1 (31)	26±2.9 (32)^b
LVD sa/m²	26±2.7 (32)	29±2.0 (33)^c	29±2.0 (33)	31±2.3 (35)^b
IVSmax sa/m²	5.2±0.9 (7.1)	5.6±0.9 (7.2)^b	4.8±0.8 (6.2)	5.3±0.7 (6.3)^b
RVD la/m²	22±5.0 (31)	26±4.5 (34)^d	26±3.3 (33)	28±2.8 (33)^d
LVD la/m²	27±3.2 (34)	30±2.5 (34)^c	30±2.2 (33)	31±2.2 (35)^b
IVSmax la/m²	5.2±1.1 (7.4)	5.6±0.9 (7.3)^b	5.0±0.8 (6.4)	5.3±0.8 (7.2)

Data are expressed as mean±SD (95th percentile), RVD, LVD=right and left ventricle
end-diastolic diameter (mm); IVSmax = maximum interventricular–septal-wallthickness
(mm); sa = short-axis, la = long-axis; m = height indexation, m2 = body
surface area indexation.
^ap-values for significant differences between controls and regular athletes.
^b pb0.05.
^c pb0.0005.
^d pb0.005.

Body surface area corrected ventricular volumes, wall-mass, and blood pressure by age category

Age categories (years)	Non-athletes				Athletes		Mature Woman
Men (n)	40	16	19	13	18	27	31	24
RV
EDV	113±15	104±22	108±14	104±17	141±18	140±17	131±19	124±19^{1, 2}
Wall-mass	12±2.1	11±2.4	11±1.5	11±1.8	14±3.3	14±2.6	15±3.6	14±2.8
LV
EDV	103±15	95±13	100±9.2	96±16	128±14	123±14	119±14	114±17^*1
Wall-mass	49±8.2	43±6.9	49±7.9	47±8.3	62±11	63±13	58±10	53±12^*2
Systolic BP	127±12	129±9.6	136±18	137±18	135±11	131±13	136±14	139±18
Diastolic BP	74±8.9	79±9.2	81±11	82±8.1	76±5.8	75±10	83±9.3^*2	82±9.3^*2

Women (n)	42	16	21	12	21	15	11	12
RV
EDV	95±10	98±17	94±12	85±12	117±10	122±17	110±11	97±8.9^{‡ 1, ‡2}
Wall-mass	10±2.1	11±2.2	10±1.3	11±1.1	13±2.0	14±1.3	14±2.8	12±2.3
LV
EDV	89±8.5	92±17	90±9.0	86±13	108±11	113±14	103±10	94±7.3^{† 1, ‡2}
Wall-mass	35±6.1	34±6.5	36±5.6	36±8.3	46±7.3	50±13	38±6.0^†2	42±7.3
Systolic BP	123±12	118±11	132±19^*2	135±19^*2	114±11	122±13	125±18	134±16^†1
Diastolic BP	73±8.8	72±5.6	80±11^*1	79±13	68±8.8	72±9.4	72±12	77±8.6^1

Data are expressed as mean±SD; RV, LV = right and left ventricle, EDV = end-diastolic volume (m^L/m²), wall-mass = end-diastolic wall-mass (g/m²), BP = blood pressure (mm Hg). p-values for significant differences between groups are marked: *pb0.05; †pb0.005; ^‡pb0.0005. Superscript numbers refer to the age category the given variable is compared to: ¹ = age 18–39, ² = age 30–39, ³ = age 40–49, ⁴ = age 50–60 years old.

Article Links

https://pubmed.ncbi.nlm.nih.gov/20060180/