Vigorous physical exercise is linked to “non-compaction” of the heart

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Nonetheless, high intensity physical training can trigger a series of physiological changes in the body, including the heart.

Exercising regularly, intensely or moderately, is a health recommendation accepted by all experts. Nonetheless, high intensity physical training can trigger a series of physiological changes in the body, including the heart. The hearts of professional athletes adapt to training in several ways, including increasing the number of structures called trabeculae inside the heart. Although this process, called hypertrabeculation, is harmless in athletes, it is also a pathological feature of non-compaction cardiomyopathy, an inherited disease that can cause sudden cardiac death.

Today, scientists at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) used cardiac magnetic resonance technology to measure exercise-related hypertrabeculation in a general non-athletic population. The results of the study have important practical implications, as a misdiagnosis of non-compaction cardiomyopathy in people who exercise regularly (whether professional athletes or hobbyists) may trigger recommendations. to stop physical exercise unnecessarily, ”explained CNIC Director General Valentín Fuster.

The study, published today in the Journal of American College of Cardiology (JACC), is part of the PESA-CNIC-SANTANDER study, whose principal investigator is Dr. Valentín Fuster. PESA, started in 2010 and recently renewed until 2030, is one of the most important cardiovascular prevention studies on the international scene. The 700 PESA participants included in the new substudy published in JACC will be monitored throughout this period, allowing for a detailed analysis of the development, reversibility, and clinical implications of this cardiac adaptation to the disease. physical exercise.

“It is crucial to distinguish this benign adaptation to exercise from cardiomyopathy without compaction, a disease with a genetic component that can have serious consequences, including heart failure, thromboembolism, arrhythmias and sudden death of origin. cardiac, ”said Dr Borja Ibáñez, clinical research director at CNIC, cardiologist at Fundación Jiménez Díaz University Hospital and head of the JACC study.

In non-compaction cardiomyopathy, “the walls of the heart become thinner and the normally compact heart muscle is replaced by the spongy (trabecular) form, in direct contact with the inside of the ventricles,” continues Dr Ibañez.

The problem is that this disease is often diagnosed in asymptomatic young people, resulting in a medical recommendation to immediately stop physical activity that can lead to sudden cardiac death. However, the presence of trabeculae is not always a sign of uncompacted cardiomyopathy. “Certain physiological situations, such as those resulting from high intensity physical training or pregnancy, are known to trigger changes in the heart structure similar to those seen in uncompacted cardiomyopathy,” explained Dr Ibañez.

Study lead author and cardiologist José de la Chica explained that “it is essential to distinguish between disease and benign physiological adaptation, both to allow appropriate medical intervention to prevent the progression of the disease. disease and to avoid recommending healthy young people to avoid participating in sports unnecessarily. . “

The association between hypertrabeculation and high intensity physical activity in professional athletes was already known. The key innovation of the new study is its combination of cardiac magnetic resonance (the gold standard diagnostic method for the analysis of cardiac structure and function) with objective measures of physical activity. “Previously, we lacked information on whether physiological hypertrabeculation occurs in the general population or is limited to elite athletes,” commented Dr. Inés García-Lunar, author of the study.

The study used cardiac magnetic resonance technology to assess accepted diagnostic criteria for uncompacted cardiomyopathy in more than 700 participants in the PESA-CNIC-SANTANDER study. These healthy Santander Bank employees have varying levels of physical activity, but none are professional athletes.

Physical activity was objectively assessed using accelerometers. These devices measure changes in movement speed in different body axes, and participants wore them for weeklong periods coinciding with each triennial PESA protocol visit. Dr de la Chica explained that “this technology allowed us to classify individual physical activity as sedentary or as light, moderate or vigorous exercise and to record the time spent in each type of activity during the week.

The study found that participants who regularly exercised vigorously during the study period had larger hearts with more muscle mass. “These changes are typical of the ‘athlete’s heart’ and are considered physiological,” García-Lunar said.

A more surprising finding was that one-third of participants with a high level of vigorous physical activity (men and women) met the diagnostic criteria for non-compaction cardiomyopathy, even though they were clearly in good health.

Previous studies had suggested that hypertrabeculation could simply be a consequence of the heart enlarging during intense physical exercise. “Thanks to data from the PESA-CNIC-SANTANDER study, we have now shown that hypertrabeculation and dilation are independent phenomena,” explains Dr de la Chica.

The main conclusions of the study are that none of the participants with trabeculated hearts showed signs of cardiomyopathy without compaction and that all other test results were within the normal range.

The authors conclude that the cardiac magnetic resonance criteria for the diagnosis of cardiomyopathy without compaction should not be interpreted in isolation. Instead, imaging results should be placed in the context of other clinical parameters, genetic testing, and level of physical activity. This is important even in a population of non-athletes to avoid misdiagnosis of the disease. A wrong diagnosis can lead to unnecessary cessation of exercise, with all the negative physical and psychological consequences associated with it.

Originally published at eurekalert


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