Metabolic spectrum

Abstract

Background

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

Non-athletic non-smoking asymptomatic adults aged 18-45 years were prospectively recruited and underwent 3Tesla cardiac MRI. Multivariate linear regression was performed to investigate independent associations of risk factor-related parameters with cardiac MRI values.

Results

We included 311 adults (age, 32 ± 7 years; men, 49%). Of them, 220 subjects had one or multiple risk factors, while 91 subjects were free of risk factors. For overweight, increased body mass index (per SD = 5.3 kg/m2) was associated with increased left ventricular (LV) mass (+7.3 g), biventricular higher end-diastolic (LV, +8.6 ml), and stroke volumes (SV; +5.0 ml), higher native T1 (+7.3 ms), and lower extracellular volume (ECV, -0.38%), whereas the higher waist-hip ratio was associated with lower biventricular volumes. Regarding hypertension, increased systolic blood pressure (per SD = 14 mmHg) was associated with increased LV mass (+6.9 g), higher LV ejection fraction (EF; +1.0%), and lower ECV (-0.48%), whereas increased diastolic blood pressure was associated with lower LV EF. In T2D, increased HbA1c (per SD = 9.0 mmol/mol) was associated with increased LV mass (+2.2 g), higher right ventricular end-diastolic volume (+3.2 ml), and higher ECV (+0.27%). Increased heart rate was linked with decreased LV mass, lower biventricular volumes, and lower T2 values.

Conclusions

Young asymptomatic adults with overweight, hypertension, and T2D show subclinical alterations in cardiac morphology, function, and tissue characteristics. These alterations should be considered in cardiac MRI-based clinical decision making.

Cardiac MRI values per gender

  Males ( n = 151)Females (n = 160)P
Left
ventricle
Mass (g)
117 ± 20
85 ± 16
<0.001
End-diastolic volume (ml)
185 ± 35
155 ± 24
<0.001
Stroke volume (ml)
109 ± 22
93 ± 16
<0.001
Ejection fraction (%)
59 ± 5
61 ± 4
<0.01
Indexed mass (g/m2)
55 ± 8
44 ± 7
<0.001
Indexed end-diastolic volume (ml/m2)
87 ± 16
80 ± 12
<0.001
Indexed stroke volume (ml/m2)
52 ± 10
48 ± 8
<0.001
Right
ventricle
End-diastolic volume (ml)
213 ± 40
170 ± 28
<0.001
Ejection fraction (%)
51 ± 4
55 ± 4
<0.001
Indexed end-diastolic volume (ml/m2)
100 ± 18
88 ± 14
<0.001
Tissue
characteristics
Native T1 (ms)1148 ± 29
1153 ± 37
0.21
Extracellular volume (%)22 ± 2
25 ± 2
<0.001
T2 (ms)38 ± 2
39 ± 2
<0.001
Indexed for body surface area

Cardiac MRI values on risk factors in females

  Controls (n = 47)Overweight (n = 69)Hypertensive (n = 8)Overweight & hypertensive (n = 25)
LVMass (g)
75 ± 11 (93)
86 ± 13 (107)
94 ± 15 (119)
95 ± 18 (125)
M/V ratio (g/ml)0.49 ± 0.06 (0.59)0.54 ± 0.07 (0.66)0.69 ± 0.18 (0.99)
0.64 ± 0.09 (0.79)
EDV (ml)156 ± 20 (189)
159 ± 24 (198)
139 ± 23 (177)
150 ± 28 (196)
ESV (ml)63 ± 11 (81)
62 ± 11 (80)
55 ± 8 (68)
58 ± 16 (84)
SV (ml)93 ± 14 (116)
97 ± 16 (123)
84 ± 17 (112)
92 ± 15 (117)
CO (l/min)6.2 ± 1.1 (8.0)
6.7 ± 1.3 (8.8)
5.7 ± 1.1 (7.5)
6.8 ± .9 (8.3)
EF (%)60 ± 5 (68)
61 ± 4 (68)
60 ± 4 (67)
62 ± 5 (70)
Mass/H2.7 (g/m2.7)17.3 ± 2.8 (21.9)
20.2 ± 3.1 (25.3)
21.5 ± 2.9 (26.3)
22.4 ± 4.2 (29.3)
EDV/H2.7 (ml/m2.7)35.7 ± 4.6 (43.3)
37.4 ± 5.1 (45.8)
32.0 ± 5.0 (40.3)
35.5 ± 6.6 (46.4)
ESV/H2.7 (ml/m2.7)14.4 ± 2.5 (18.5)
14.7 ± 2.7 (19.1)
12.6 ± 1.7 (15.4)
13.7 ± 3.8 (20.0)
SV/H2.7 (ml/m2.7)21.3 ± 3.2 (26.6)
22.7 ± 3.3 (28.1)
19.4 ± 3.8 (25.7)
21.7 ± 3.3 (27.1)
CO/H2.7 (l/min/m2.7)1.41 ± 0.24 (1.80)
1.58 ± 0.28 (2.04)
1.31 ± 0.24 (1.70)
1.61 ± 0.22 (1.97)
RVEDV (ml)
173 ± 22 (209)
176 ± 28 (222)
149 ± 23 (187)
159 ± 29 (207)
ESV (ml)
79 ± 13 (100)
80 ± 16 (106)
64 ± 11 (82)
69 ± 16 (95)
SV (ml)
94 ± 14 (117)
96 ± 17 (124)
85 ± 17 (113)
91 ± 15 (116)
CO (l/min)
6.2 ± 1.1 (8.0)
6.7 ± 1.3 (8.8)
5.7 ± 1.1 (7.5)
6.7 ± .9 (8.2)
EF (%)
54 ± 4 (61)
55 ± 4 (62)
57 ± 5 (65)
57 ± 4 (64)
EDV/H2.7 (ml/m2.7)
39.6 ± 5.3 (48.3)
41.4 ± 6.2 (51.6)
34.3 ± 4.7 (42.0)
37.7 ± 6.6 (48.6)
ESV/H2.7 (ml/m2.7)
18.2 ± 3.0 (23.1)
18.8 ± 3.8 (25.0)
14.8 ± 2.3 (18.6)
16.2 ± 3.8 (22.4)
SV/H2.7 (ml/m2.7)
21.5 ± 3.3 (26.9)
22.6 ± 3.4 (28.2)
19.5 ± 3.7 (25.6)
21.4 ± 3.3 (26.8)
CO/H2.7 (l/min/m2.7)
1.42 ± 0.24 (1.81)
1.58 ± 0.28 (2.04)
1.31 ± 0.23 (1.69)
1.59 ± 0.22 (1.95)
Native T1 (ms)1150 ± 37 (1211)
1153 ± 35 (1211)
1153 ± 41 (1220)
1156 ± 44 (1228)
Extracellular volume (%)25.8 ± 2.1 (29.3)
24.9 ± 2.0 (28.2)
24.5 ± 1.9 (27.6)
24.5 ± 2.2 (28.1)
T2 (ms)39.6 ± 1.8 (42.6)
38.8 ± 2.0 (42.1)
38.5 ± 1.6 (41.1)
38.0 ± 2.3 (41.8)
Data noted as mean ± standard deviation (95th percentile). Indexation by height to the power of 2.7 (H2.7) instead of body surface area to avoid masking the effect of overweight. Cardiac MRI values in type 2 diabetes populations were not reported due to small group size. LV left ventricle, M/V mass/volume, EDV end-diastolic volume, ESV end-systolic volume, SV stroke volume, CO cardiac output, EF ejection fraction, RV right ventricle.

Cardiac MRI values on risk factors in males

  Controls (n = 44)Overweight (n = 63)Hypertensive (n = 15)Overweight & hypertensive (n = 18)
LVMass (g)
107 ± 16 (133)
118 ± 16 (144)
127 ± 24 (166)
127 ± 24 (166)
M/V ratio (g/ml)0.58 ± 0.10 (0.74)
0.66 ± 0.11 (0.84)
0.63 ± 0.07 (0.75)
0.71 ± 0.10 (0.88)
EDV (ml)188 ± 33 (242)
183 ± 34 (239)
203 ± 32 (256)
181 ± 39 (245)
ESV (ml)77 ± 16 (103)
75 ± 16 (101)
85 ± 16 (111)
72 ± 19 (103)
SV (ml)111 ± 22 (147)
107 ± 21 (142)
117 ± 18 (147)
109 ± 23 (147)
CO (l/min)7.3 ± 1.6 (9.9)
7.3 ± 1.5 (9.8)
7.6 ± 1.0 (9.2)
8.2 ± 1.6 (10.8)
EF (%)59 ± 5 (67)
59 ± 5 (67)
58 ± 4 (65)
60 ± 5 (68)
Mass/H2.7 (g/m2.7)20.7 ± 3.2 (26.0)
23.2 ± 2.9 (28.0)
23.1 ± 3.9 (29.5)
24.3 ± 4.3 (31.4)
EDV/H2.7 (ml/m2.7)36.2 ± 5.3 (44.9)
36.0 ± 6.1 (46.0)
36.9 ± 5.0 (45.1)
34.5 ± 6.5 (45.2)
ESV/H2.7 (ml/m2.7)14.8 ± 2.8 (19.4)
14.8 ± 3.0 (19.7)
15.5 ± 2.6 (19.8)
13.8 ± 3.2 (19.1)
SV/H2.7 (ml/m2.7)21.4 ± 3.5 (27.2)
21.1 ± 3.9 (27.5)
21.4 ± 3.1 (26.5)
20.8 ± 4.1 (27.5)
CO/H2.7 (l/min/m2.7)1.39 ± 0.26 (1.82)
1.43 ± 0.29 (1.91)
1.39 ± 0.17 (1.67)
1.56 ± 0.27 (2.00)
RVEDV (ml)
215 ± 35 (273)
211 ± 41 (278)
231 ± 40 (297)
206 ± 40 (272)
ESV (ml)
104 ± 18 (134)
104 ± 23 (142)
113 ± 23 (151)
97 ± 21 (132)
SV (ml)
111 ± 21 (146)
107 ± 21 (142)
119 ± 22 (155)
109 ± 22 (145)
CO (l/min)
7.2 ± 1.5 (9.7)
7.3 ± 1.5 (9.8)
7.7 ± 1.3 (9.8)
8.2 ± 1.6 (10.8)
EF (%)
51 ± 4 (58)
51 ± 4 (58)
51 ± 4 (58)
53 ± 4 (60)
EDV/H2.7 (ml/m2.7)
41.4 ± 5.6 (50.6)
41.5 ± 7.4 (53.7)
42.0 ± 5.7 (51.4)
39.4 ± 7.0 (50.9)
ESV/H2.7 (ml/m2.7)
20.1 ± 3.2 (25.4)
20.4 ± 4.3 (27.5)
20.4 ± 3.4 (26.0)
18.5 ± 3.6 (24.4)
SV/H2.7 (ml/m2.7)
21.3 ± 3.3 (26.7)
21.1 ± 3.9 (27.5)
21.5 ± 3.4 (27.1)
20.9 ± 4.1 (27.6)
CO/H2.7 (l/min/m2.7)
1.39 ± 0.26 (1.82)
1.43 ± 0.28 (1.89)
1.40 ± 0.18 (1.70)
1.57 ± 0.28 (2.03)
Native T1 (ms)1140 ± 25 (1181)
1153 ± 25 (1194)
1147 ± 28 (1193)
1146 ± 28 (1192)
Extracellular volume (%)22.8 ± 1.5 (25.3)
21.9 ± 1.9 (25.0)
22.8 ± 1.4 (25.1)
21.7 ± 1.3 (23.8)
T2 (ms)38.2 ± 1.7 (41.0)
37.5 ± 1.5 (40.0)
37.9 ± 1.3 (40.0)
36.8 ± 2.0 (40.1)
Data noted as mean ± standard deviation (95th percentile). Indexation by height to the power of 2.7 (H2.7) instead of body surface area to avoid masking the effect of overweight. Cardiac MRI values in type 2 diabetes populations were not reported due to small group size. LV left ventricle, M/V mass/volume, EDV end-diastolic volume, ESV end-systolic volume, SV stroke volume, CO cardiac output, EF ejection fraction, RV right ventricle.

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