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Hedman, K., Moneghetti, K. J., Christle, J. W., Bagherzadeh, S. P., Amsallem, M., Ashley, E., . . . Haddad, F. (2019). Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling. Heart, 105(16), 1223-1230
Open this publication in new window or tab >>Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling
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2019 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 105, no 16, p. 1223-1230Article in journal (Refereed) Published
Abstract [en]

Objectives To explore blood pressure (BP) in athletes at preparticipation evaluation (PPE) in the context of recently updated US and European hypertension guidelines, and to determine the relationship between BP and left ventricular (LV) remodelling.Methods In this retrospective study, athletes aged 13–35 years who underwent PPE facilitated by the Stanford Sports Cardiology programme were considered. Resting BP was measured in both arms; repeated once if >=140/90 mm Hg. Athletes with abnormal ECGs or known hypertension were excluded. BP was categorised per US/European hypertension guidelines. In a separate cohort of athletes undergoing routine PPE echocardiography, we explored the relationship between BP and LV remodelling (LV mass, mass/volume ratio, sphericity index) and LV function.Results In cohort 1 (n=2733, 65.5% male), 34.3% of athletes exceeded US hypertension thresholds. Male sex (B=3.17, p<0.001), body mass index (BMI) (B=0.80, p<0.001) and height (B=0.25, p<0.001) were the strongest independent correlates of systolic BP. In the second cohort (n=304, ages 17–26), systolic BP was an independent correlate of LV mass/volume ratio (B=0.002, p=0.001). LV longitudinal strain was similar across BP categories, while higher BP was associated with slower early diastolic relaxation.Conclusion In a large contemporary cohort of athletes, one-third presented with BP levels above the current US guidelines’ thresholds for hypertension, highlighting that lowering the BP thresholds at PPE warrants careful consideration as well as efforts to standardise measurements. Higher systolic BP was associated with male sex, BMI and height and with LV remodelling and diastolic function, suggesting elevated BP in athletes during PPE may signify a clinically relevant condition.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-159932 (URN)10.1136/heartjnl-2019-314815 (DOI)
Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2019-08-28Bibliographically approved
Hedman, K., Sunnerud, S., Carlén, A., Janzon, M. & Nylander, E. (2019). From guidelines to the sidelines: implementation of cardiovascular preparticipation evaluation in sports clubs is lagging.. British Journal of Sports Medicine, 53(1), 3-4
Open this publication in new window or tab >>From guidelines to the sidelines: implementation of cardiovascular preparticipation evaluation in sports clubs is lagging.
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2019 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 1, p. 3-4Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
athlete’s heart, implementation, position statement
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-152136 (URN)10.1136/bjsports-2018-099297 (DOI)000455231200003 ()29921655 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2019-08-28
Hedman, K., Carlén, A., Sunnerud, S., Nylander, E. & Janzon, M. (2018). Hjärtscreening av elitidrottare: Låg följsamhet till RF:s rekommendationer. Idrottsmedicin, 1/18, 16-19
Open this publication in new window or tab >>Hjärtscreening av elitidrottare: Låg följsamhet till RF:s rekommendationer
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2018 (Swedish)In: Idrottsmedicin, ISSN 1103-7652, Vol. 1/18, p. 16-19Article in journal (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-152134 (URN)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2019-08-28
Sunnerud, S., Nylander, E., Janzon, M., Carlén, A. & Hedman, K. (2018). Låg följsamhet till rekommenderad hjärtscreening av elitidrottare - Lägesanalys i Östergötland. Läkartidningen, 115, 185-187, Article ID EWLM.
Open this publication in new window or tab >>Låg följsamhet till rekommenderad hjärtscreening av elitidrottare - Lägesanalys i Östergötland
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2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, p. 185-187, article id EWLMArticle in journal (Refereed) Published
Abstract [en]

Low adherence to recommended pre-participation cardiac evaluation of Swedish athletes Pre-participation cardiac evaluation of athletes is recommended by international organizations like the European Society of Cardiology and the American Heart Association, as well as by the Swedish Sports Confederation. The purpose of the evaluation is to prevent sudden cardiac death in athletes by early identification of individuals at risk. To our knowledge, no previous study has been made regarding the implementation of pre-participation cardiac evaluation of athletes in Sweden. We performed an electronical survey addressing sports clubs in one out of 21 districts in which the Swedish Sports Confederation is geographically divided. Only four out of 22 responding clubs with elite athletes preformed cardiac evaluation. Lack of knowledge about the recommendations as well as how to perform the evaluation were mentioned as reasons not to evaluate the athletes. Our results indicate the need for more information about pre-participation cardiac evaluation of athletes in Sweden.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-152133 (URN)29381184 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2019-08-28Bibliographically approved
Hedman, K., Bjarnegård, N. & Länne, T. (2017). Left Ventricular Adaptation to 12 Weeks of Indoor Cycling at the Gym in Untrained Females.. International Journal of Sports Medicine, 38(9), 653-658
Open this publication in new window or tab >>Left Ventricular Adaptation to 12 Weeks of Indoor Cycling at the Gym in Untrained Females.
2017 (English)In: International Journal of Sports Medicine, ISSN 0172-4622, E-ISSN 1439-3964, Vol. 38, no 9, p. 653-658Article in journal (Refereed) Published
Abstract [en]

Cross-sectional studies provide evidence of larger cardiac dimensions and mass in endurance trained than in untrained females. Much less is known regarding adaptations in cardiac function following training in untrained subjects. We aimed to study left ventricular (LV) adaptation to indoor cycling in previously untrained females, in regard of LV dimensions, mass and function. 42 sedentary females were divided into 2 equally sized groups, either training indoor cycling at regular classes at a local gym for 12 weeks, in average 2.6 times per week, or maintaining their sedentary lifestyle. Echocardiography at rest and a maximal exercise test were performed before and after the intervention. Exercise capacity increased in average 16% in the exercise group (p<0.001), together with decreased heart rate at rest (p<0.05) and at 120 watts steady-state (p<0.001). There were no difference in systolic or diastolic function following the intervention and minimal increases in LV internal diameter in diastole (+1 mm, p<0.01). LV mass was unchanged with training (137±25 vs. 137±28 g, p=0.911). Our findings indicate that attending indoor cycling classes at a gym 2-to-3 times per week for 12 weeks is enough to improve exercise capacity, while a higher volume of training is required to elicit cardiac adaptations.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-140006 (URN)10.1055/s-0043-112341 (DOI)000407018300001 ()28704880 (PubMedID)
Available from: 2017-08-25 Created: 2017-08-25 Last updated: 2019-08-28Bibliographically approved
Hedman, K. (2016). Cardiac function and long-term volume load: Physiological investigations in endurance athletes and in patients operated on for aortic regurgitation. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Cardiac function and long-term volume load: Physiological investigations in endurance athletes and in patients operated on for aortic regurgitation
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims. The heart is a remarkably adaptable organ, continuously changing its output to match metabolic demands and haemodynamic load. But also in long-term settings, such as in chronic or repeated volume load, there are changes in cardiac dimensions and mass termed cardiac hypertrophy. Depending on the stimulus imposing the volume load this hypertrophy differs in extent and phenotype. We aimed to study cardiac function in two settings with long-term volume load, including patients previously operated for aortic regurgitation and healthy females performing endurance training.

Methods. In paper I, 21 patients (age 52±12 years, all male) operated on with aortic valve replacement for aortic regurgitation (AR) underwent a cardiopulmonary exercise test (CPET) and an echocardiographic evaluation in average 49±15 months following surgery. The peak oxygen uptake (peakVO2) was compared to results from a pre-operative and a six months follow-up, and relations to echocardiographic measures were determined.

In papers II–IV, 48 endurance trained female athletes (ATH, age 21±2 years) were compared to 46 untrained females (CON, age 21±2 years) regarding echocardiographic measures of cardiac dimensions, global and regional cardiac function and maximal aerobic capacity (VO2max) determined with CPET. Relations between VO2max and cardiac variables were explored.

Results. In paper I, peakVO2 had decreased from 26±6 to 23±5 mL/kg/min in patients from the first to second, late follow-up. This decrease was larger than expected by their increased age alone, and a majority of patients had a cardiorespiratory fitness below average according to reference values from healthy subjects of the same age, sex and weight.

In papers II–IV, we found that ATH (VO2max 52±5 mL/kg/min) had larger atrial, ventricular and inferior vena cava dimensions compared to CON (VO2max 39±5 mL/kg/min). ATH had increased measures of right ventricular (RV) systolic function (RV atrioventricular plane displacement indexed by cardiac length 2.5±0.3 vs. 2.3±0.3, p=0.001) and left ventricular (LV) diastolic function (mitral E-wave velocity 0.92±0.17 vs. 0.86±0.11 m/s, p=0.029). In addition, systolic synchrony was similar between groups while there were heterogeneous differences in diastolic and systolic function across different myocardial segments. VO2max was most strongly related to LV end-diastolic volume (r=0.709, p<0.001).

Conclusions. Decreasing peakVO2 following surgery for AR, despite a normalisation in cardiac dimension could either be a result of a remaining, slight myocardial dysfunction or post-operative negative influence on cardiac performance by filling disturbances or the prosthetic valve itself, or, a sign of an inadequate post-operative level of physical activity and lack of exercise training. This stresses the importance of post-operative management and methods for increasing aerobic capacity, where exercise testing could be valuable for guiding patients and tailoring exercise protocols.

The eccentric cardiac hypertrophy in ATH, symmetrically distributed across the heart, depicts the physiological hypertrophy in response to volume load in endurance training. Cardiac function was similar, or for some measures slightly improved in ATH compared to CON and LV dimensions, rather than cardiac function, were predictors of VO2max. As the heart of female athletes has been far less studied than that in males, our results add knowledge regarding the female athlete’s heart, and our results of differences in segmental cardiac function merits further research.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. p. 90
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1489
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-123316 (URN)10.3384/diss.diva-123316 (DOI)978-91-7685-916-2 (ISBN)
Public defence
2016-01-22, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-12-11 Created: 2015-12-10 Last updated: 2019-10-29Bibliographically approved
Hedman, K., Tamás, É., Bjarnegård, N., Brudin, L. & Nylander, E. (2015). Cardiac systolic regional function and synchrony in endurance trained and untrained females. BMJ Open Sport & Exercise Medicine, 25(1), Article ID :e000015.
Open this publication in new window or tab >>Cardiac systolic regional function and synchrony in endurance trained and untrained females
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2015 (English)In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 25, no 1, article id :e000015Article in journal (Refereed) Published
Abstract [en]

Background Most studies on cardiac function in athletes describe overall heart function in predominately male participants. We aimed to compare segmental, regional and overall myocardial function and synchrony in female endurance athletes (ATH) and in age-matched sedentary females (CON).

Methods In 46 ATH and 48 CON, echocardiography was used to measure peak longitudinal systolic strain and myocardial velocities in 12 left ventricular (LV) and 2 right ventricular (RV) segments. Regional and overall systolic function were calculated together with four indices of dyssynchrony.

Results There were no differences in regional or overall LV systolic function between groups, or in any of the four dyssynchrony indices. Peak systolic velocity (s′) was higher in the RV of ATH than in CON (9.7±1.5 vs 8.7±1.5 cm/s, p=0.004), but not after indexing by cardiac length (p=0.331). Strain was similar in ATH and CON in 8 of 12 LV myocardial segments. In septum and anteroseptum, basal and mid-ventricular s′ was 6–7% and 17–19% higher in ATH than in CON (p<0.05), respectively, while s′ was 12% higher in CON in the basal LV lateral wall (p=0.013). After indexing by cardiac length, s′ was only higher in ATH in the mid-ventricular septum (p=0.041).

Conclusions We found differences between trained and untrained females in segmental systolic myocardial function, but not in global measures of systolic function, including cardiac synchrony. These findings give new insights into cardiac adaptation to endurance training and could also be of use for sports cardiologists evaluating female athletes.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-122839 (URN)10.1136/bmjsem-2015-000015 (DOI)
Available from: 2015-11-26 Created: 2015-11-26 Last updated: 2019-08-28Bibliographically approved
Hedman, K., Tamás, E., Henriksson, J., Bjarnegård, N., Brudin, L. & Nylander, E. (2015). Female athlete's heart: Systolic and diastolic function related to circulatory dimensions. Scandinavian Journal of Medicine and Science in Sports, 25(3), 372-381
Open this publication in new window or tab >>Female athlete's heart: Systolic and diastolic function related to circulatory dimensions
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2015 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 25, no 3, p. 372-381Article in journal (Refereed) Published
Abstract [en]

There are relatively few studies on female athletes examining cardiac size and function and how these measures relate to maximal oxygen uptake (VO2max ). When determining sports eligibility, it is important to know what physiological adaptations and characteristics may be expected in female athletes, taking body and cardiac size into account. The purposes of this study were (a) to compare right and left heart dimensions and function in female endurance athletes (ATH) and in non-athletic female controls of similar age (CON); and (b) to explore how these measures related to VO2max . Forty-six ATH and 48 CON underwent a maximal bicycle exercise test and an echocardiographic examination at rest, including standard and color tissue Doppler investigation. All heart dimensions indexed for body size were larger in ATH (all P < 0.01). The diastolic mitral E/A ratio was 27% higher in ATH (P < 0.001) while systolic left and right atrio-ventricular longitudinal displacement was 7% (P = 0.002) and 15% (P < 0.001) larger in ATH, respectively. Half (50.3%) of the variability in VO2max could be explained by left ventricular end-diastolic volume. Our results could be useful in evaluating female endurance athletes with suspected cardiac disease and contribute to understanding differences between female athletes and non-athletes.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113770 (URN)10.1111/sms.12246 (DOI)000354568800021 ()24840312 (PubMedID)
Available from: 2015-01-30 Created: 2015-01-30 Last updated: 2019-08-28
Hedman, K., Nylander, E., Henriksson, J., Bjarnegård, N., Brudin, L. & Tamás, É. (2015). The size and shape of the inferior vena cava in trained and untrained females in relation to maximal oxygen uptake.
Open this publication in new window or tab >>The size and shape of the inferior vena cava in trained and untrained females in relation to maximal oxygen uptake
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2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background. The increase in cardiac dimensions following endurance training is well acknowledged. A few studies report a larger inferior vena cava (IVC) in trained, predominatly male subjects while athlete-control studies upon females are lacking. Previous studies were constrained to long-axis measurements, and there are no reports in the literature on IVC short-axis dimensions and shape in athletes.

Methods and Results. Forty-eight sedentary and 46 endurance trained females (mean age 21±2 years, VO2max 39±5 vs. 52±5 mL×kg-1×min-1, p<0.001) underwent echocardiographic examination including IVC diameter and cross-sectional area measured in the subcostal view. IVC shape was calculated as the ratio of short-axis major-to-minor diameter.

Five out of eight IVC dimensions were larger in trained females, including maximal long-axis diameter (mean 24±3 vs. 20±3 mm, p<0.001) and maximal short-axis area (mean 5.5±1.5 vs. 4.7±1.4 cm2, p=0.022). Both groups presented with a slightly oval IVC with no differences between the groups in IVC shape or inspiratory decrease in any IVC dimension. The IVC long-axis diameter reflected the minor-axis diameter obtained in the short-axis view, during both expiration and inspiration. Positive correlations were seen between maximal IVC long-axis diameter and maximal oxygen uptake (r=0.52, p<0.01), left ventricular end-diastolic volume (r=0.46, p<0.01) and right atrial area (r=0.49, p<0.01).

Conclusion. The IVC was larger in endurance trained than in untrained females but showed similar shape and inspiratory decrease in dimensions. The long-axis IVC diameter was related to maximal oxygen uptake.

Keywords
Inferior Vena Cava, Athlete’s heart, Exercise Training, Sports Cardiology, Maximal Oxygen Uptake
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-123315 (URN)
Available from: 2015-12-10 Created: 2015-12-10 Last updated: 2019-08-28Bibliographically approved
Hedman, K., Tamas, E. & Nylander, E. (2012). Decreased aerobic capacity 4 years after aortic valve replacement in male patients operated upon for chronic aortic regurgitation. Clinical Physiology and Functional Imaging, 32(3), 167-171
Open this publication in new window or tab >>Decreased aerobic capacity 4 years after aortic valve replacement in male patients operated upon for chronic aortic regurgitation
2012 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 32, no 3, p. 167-171Article in journal (Refereed) Published
Abstract [en]

Exercise testing is underutilized in patients with valve disease. We have previously found a low physical work capacity in patients with aortic regurgitation 6 months after aortic valve replacement (AVR). The aim of this study was to evaluate aerobic capacity in patients 4 years after AVR, to study how their peak oxygen uptake (peakVO2) had changed postoperatively over a longer period of time. Twenty-one patients (all men, 52 +/- 13 years) who had previously undergone cardiopulmonary exercise testing (CPET) pre- and 6 months postoperatively underwent maximal exercise testing 49 +/- 15 months postoperatively using an electrically braked bicycle ergometer. Breathing gases were analysed and the patients physical fitness levels categorized according to angstrom strands and Wassermans classifications. Mean peakVO2 was 22.8 +/- 5.1 ml x kg-1 x min-1 at the 49-month follow-up, which was lower than at the 6-month follow-up (25.6 +/- 5.8 ml x kg-1 x min-1, P = 0.001). All but one patient presented with a physical fitness level below average using angstrom strands classification, while 13 patients had a low physical capacity according to Wassermans classification. A significant decrease in peakVO2 was observed from six to 49 months postoperatively, and the decrease was larger than expected from the increased age of the patients. CPET could be helpful in timing aortic valve surgery and for the evaluation of need of physical activity as part of a rehabilitation programme.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
aortic valve insufficiency, cardiopulmonary exercise testing, exercise test, open heart surgery, peak oxygen uptake, physical capacity, physical fitness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-77090 (URN)10.1111/j.1475-097X.2011.01072.x (DOI)000302545300001 ()
Note

Funding Agencies|Swedish Heart and Lung foundation||County Council of Ostergotland, Sweden||

Available from: 2012-05-04 Created: 2012-05-04 Last updated: 2019-08-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3751-7180

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