Indicators of reduced heart function found in some elite athletes

By Melanie Hinze

One in six elite athletes have indicators that would normally suggest reduced heart function, according to research published recently in Circulation.

The study authors recruited 281 elite endurance athletes (79.7% male) from elite training programs within Australia and Belgium. Participants underwent cardiac phenotyping, genetic analyses and recording of clinical events over a mean of 4.4 years. The authors then compared athletes with normal ejection fraction (EF) against those with reduced EF, which was defined as left ventricular EF <50%, right ventricular EF <45% or both, using cardiac magnetic resonance imaging.

Of the 281 athletes, 44 (15.7%) had reduced EF on cardiac imaging: 12 had reduced left ventricular EF, 14 had reduced ventricular EF and 18 had both.

Athletes with reduced EF had a higher burden of ventricular premature beats than those with normal EF (13.6% vs 3.8% with >100 ventricle beats/24 hours, respectively; p=0.008), as well as lower left ventricular global longitudinal strain (−17%±2% vs −19%±2%, respectively; p<0.001). Athletes with reduced EF also had a higher mean LVESVi-PRS – a validated polygenic risk score for indexed left ventricular end-systolic volume, previously associated with dilated cardiomyopathy.

The authors concluded that reduced EF occurred in about one in six elite endurance athletes and was related to genetic predisposition in addition to exercise training. They suggested that genetic and imaging markers might help identify endurance athletes in whom scrutiny about long-term clinical outcomes may be appropriate.

Study author, Associate Professor André La Gerche, who heads the Heart, Exercise and Research Trials (HEART) Laboratory that is jointly supported by St Vincent’s Institute of Medical Research, Melbourne, and the Victor Chang Cardiac Research Institute, Sydney, told Medicine Today that this research had both theoretical and practical elements.

From a theoretical perspective, it provides the first insights into the factors that contribute to the most extreme athletic heart changes.

‘We describe an association between the most extreme heart changes and a polygenic risk score for dilated cardiomyopathy (an accumulation of uncommon genetic variants that have previously been noted in patients with heart failure),’ he said.

On a practical level, he said it highlighted that the cardiac management of these athletic individuals should be undertaken by specialists familiar with the range of changes that may be expected in this population.

Coauthor, Professor Diane Fatkin of the Victor Chang Cardiac Research Institute, who undertook the genetic analysis of athletes, said that for GPs, this research suggested that endurance athletes may need to be checked and monitored over time for cardiac defects.

‘A positive family history of heart disease raises clinical suspicion,’ she said.

‘In the future, genetic screening may be useful to guide sports choices and the level of competitive activity,’ she added.

Circulation 2023; 149: doi: 10.1161/CIRCULATIONAHA. 122.063777.