EHJ:高强度耐力训练引发心脏损伤
2011-12-12 巩睿智 生物谷
最近一篇发表在《欧洲心脏杂志》(European Heart Journal)上的研究表明,马拉松等高强度耐力锻炼可引发右心室损害。文章作者澳大利亚墨尔本大学的André La Gerche博士称,训练有素的耐力运动员在参加比赛后,其右心室功能会下降,约一周后恢复正常。 在进行心脏磁共振(MRI)检查时发现,少数运动员有亚临床心肌疤痕形成。说明反复的过度耐力锻炼可能导致右心室发生更大范围的变化,
最近一篇发表在《欧洲心脏杂志》(European Heart Journal)上的研究表明,马拉松等高强度耐力锻炼可引发右心室损害。文章作者澳大利亚墨尔本大学的André La Gerche博士称,训练有素的耐力运动员在参加比赛后,其右心室功能会下降,约一周后恢复正常。
在进行心脏磁共振(MRI)检查时发现,少数运动员有亚临床心肌疤痕形成。说明反复的过度耐力锻炼可能导致右心室发生更大范围的变化,或导致心肌纤维化。而左心室功能没有明显变化,从侧面反映出右心室可能对运动引发的心脏功能损害更为敏感。
研究者研究了40名平均年龄为37岁的运动员,包括马拉松选手、全能三项选手、高山自行车赛车手和超铁人三项选手。他们每周都要接受超过10小时的训练,而且在最近举行的耐力比赛中进入前1/4,而且没有心脏症状及危险因素。研究者分别对运动员在比赛前3周,比赛后,和比赛6到11天进行了心脏检查。
研究结果发现,同基线水平相比,右心室功能容量有所增加,且在比赛后,所有检查结果都表明右心室功能下降,而左心室功能未受影响:心肌损伤的两个生物标记(肌钙蛋白I和前脑利尿钠肽)在显着上升,并伴有右室射血分数降低,但左室射血分数正常。右室射血分数下降与比赛时间的延长及氧摄取峰值增加显着相关。在比赛6到11天后,大多数右心室功能的检查都恢复正常,只有右心室应变率仍较低。
在接受了心脏MRI检查的39位运动员中,5名出现了室间隔增强延迟,表明这些运动员可能患有亚临床心肌纤维化。与其他运动员相比,这些运动员参加耐力运动的时间较长,且其右室射血分数更低。
作者指出,这些MRI表现的具体意义仍需进一步研究。(生物谷bioon.com)
延伸阅读:
CIRCULATION:长期强化运动训练大鼠模型的心脏致心律失常性重构
doi:10.1093/eurheartj/ehr397
Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes
André La Gerche1, Andrew T. Burns, Don J. Mooney, Warrick J. Inder,Andrew J. Taylor, Jan Bogaert, Andrew I. MacIsaac, Hein Heidbüchel and David L. Prior.
Aims Endurance training may be associated with arrhythmogenic cardiac remodelling of the right ventricle (RV). We examined whether myocardial dysfunction following intense endurance exercise affects the RV more than the left ventricle (LV) and whether cumulative exposure to endurance competition influences cardiac remodelling (including fibrosis) in well-trained athletes.
Methods and results Forty athletes were studied at baseline, immediately following an endurance race (3-11 h duration) and 1-week post-race. Evaluation included cardiac troponin (cTnI), B-type natriuretic peptide, and echocardiography [including three-dimensional volumes, ejection fraction (EF), and systolic strain rate]. Delayed gadolinium enhancement (DGE) on cardiac magnetic resonance imaging (CMR) was assessed as a marker of myocardial fibrosis. Relative to baseline, RV volumes increased and all functional measures decreased post-race, whereas LV volumes reduced and function was preserved. B-type natriuretic peptide (13.1 ± 14.0 vs. 25.4 ± 21.4 ng/L, P = 0.003) and cTnI (0.01 ± .03 vs. 0.14 ± .17 μg/L, P < 0.0001) increased post-race and correlated with reductions in RVEF (r = 0.52, P = 0.001 and r = 0.49, P = 0.002, respectively), but not LVEF. Right ventricular ejection fraction decreased with increasing race duration (r = ?0.501, P < 0.0001) and VO2max (r = ?0.359, P = 0.011). Right ventricular function mostly recovered by 1 week. On CMR, DGE localized to the interventricular septum was identified in 5 of 39 athletes who had greater cumulative exercise exposure and lower RVEF (47.1 ± 5.9 vs. 51.1 ± 3.7%, P = 0.042) than those with normal CMR.
Conclusion Intense endurance exercise causes acute dysfunction of the RV, but not the LV. Although short-term recovery appears complete, chronic structural changes and reduced RV function are evident in some of the most practiced athletes, the long-term clinical significance of which warrants further study.
作者:巩睿智
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#耐力训练#
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