JACC Focus Seminar: Exercise, Cardiovascular Disease, and the Athlete’s Heart
JACC Focus Seminar
The Athlete’s Heart—Challenges and Controversies: JACC Focus Seminar 4/4

https://doi.org/10.1016/j.jacc.2022.07.014Get rights and content
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Highlights

  • Regular exercise promotes structural, functional, and electrical remodeling of the heart, with significant exercise-related remodeling referred to as the “athlete’s heart.”

  • Significant exercise-related remodeling is rarely associated with adverse clinical effects, such as AF and other arrhythmias.

  • Both sex and genetics influence the cardiac response to exercise, and there are marked disparities in research and understanding of female vs male athletes’ hearts.

Abstract

Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the “athlete’s heart,” with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman’s vs sportswoman’s heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete’s heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.

Key Words

athlete’s heart
atrial fibrillation
cardiovascular
exercise
gender
sex

Abbreviations and Acronyms

AF
atrial fibrillation
ARVC
arrhythmogenic right ventricular cardiomyopathy
CACS
coronary artery calcium score
CMR
cardiac magnetic resonance
DCM
dilated cardiomyopathy
ECG
electrocardiogram
HCM
hypertrophic cardiomyopathy
LV
left ventricular
RV
right ventricular
SCD
sudden cardiac death
TTNtv
truncating TTN variants
TWI
T-wave inversion

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Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

Carl Lavie, MD, served as Guest Associate Editor for this paper. Christie M. Ballantyne, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.