ABC | Volume 111, Nº6, December 2018

Original Article Silva et al Cardiac and vascular features in athletes Arq Bras Cardiol. 2018; 111(6):772-781 Table 1 – General characteristics of the study participants PG (n = 16) Mean ± SD (95% CI) RG (n = 24) Mean ± SD (95% CI) p-value Age (years) 29.9 ± 4.4 (27.5–32.2) Min 20 and Max 36 28.7 ± 5.7 (26.3–31.1) Min 18 and Max 40 0.490 Body mass (kg) 99.2 ± 21.5 (87.6–110.7) Min 75 and Max 135 71.7 ± 9.2 (67.7–75.6) Min 58 and Max 84 < 0.001 Height (cm) 176 ± 0.8 (172–181) Min 164 and Max 195 175 ± 0.8 (172–179) Min 161 and Max 193 0.736 Chest circumference (cm) 113.2 ± 13.4 (106–120.4) Min 94.5 and Max 144 86.9 ± 8.6 (83.2–90.5) Min 61 and Max 100 < 0.001 Waist circumference (cm) 95.1 ± 12.9 (88.2–102) Min 78 and Max 117 78.6 ± 5.7 (76.2–81.1) Min 69 and Max 92 < 0.001 Duration of training (years) 5.12 ± 2.0 (4.0–6.2) Min 3 and Max 10 7.8 ± 2.6 (6.7–8.9) Min 3 and Max 10 0.001 Weekly duration of training (days) 3.9 ± 1.0 (3.3–4.4) Min 3 and Max 5 5.4 ± 1.0 (4.9–5.8) Min 3 and Max 7 < 0.001 Daily duration of training (min/day) 69.3 ± 14.4 (61.7–77.0) Min 60 and Max 90 98.7 ± 28.6 (86.6–110.8) Min 60 and Max 120 0.001 PG: powerlifters group; RG: long-distance runners group. Weekly number of training sessions and session average time correspond to the average duration for the last 3 months. Differences between means were assessed using Student’s t Test for independent samples. interval. We conducted Student's t Test for independent samples to assess differences between groups and calculated Pearson’s linear correlation coefficients ( α = 0.05 for all tests). All statistical analyses were performed using SPSS Statistics (version 21 for Windows). Results The participants had similar age and height (Table 1). However, all anthropometric measurements for PG were greater compared to distance RG. In turn, Table 2 shows loads for the squat, bench press, and deadlift exercises and total load (total sum of these three exercises). For all types of exercises, weight loads were higher in PG than RG as expected. The total load was greater by ~133% in PG than RG. The differences remained unchanged when loads were adjusted for body mass. Table 3 shows hemodynamic and cardiopulmonary parameters. Powerlifters had higher resting SBP (~10%) and resting DBP (~12%); the absolute differences between the two groups were 13.6 mmHg and 10.1 mmHg, respectively. Resting heart rate was higher in PG compared to RG (~19%, Δ15.7 bpm). VO 2 max was much higher in RG than PG (~65%): the highest VO 2 max value among powerlifters was lower than the lowest VO 2 max value among runners. Table 4 shows the echocardiographic results. As for cardiovascular adaptations, aorta diameter, left atrium (LA) diameter, right ventricle diameter, LV systolic diameter, and LV diastolic diameter were similar in both groups. However, PG showed greater interventricular septum thickness (Δ2.4 mm) and posterior wall thickness (Δ1.2 mm). They also showed greater LV mass (Δ46.5 g), but this difference disappeared after adjusting for BSA. As for diastolic function, LV diastolic volume, transmitral E wave, e' wave, and E/e' ratio were similar in both groups. However, LA volume (~22%), and LA volume adjusted for BSA (~40%) were found in PG, when compared to RG, but they were all within normal ranges. Although PG showed some degree of anatomical remodeling and different diastolic function parameters compared to RG, systolic function reflected in LV systolic volume, ejection fraction, and ejection fraction calculated by Simpson’s rule were similar in both groups. Of the 40 participants, 9 (22.5%) had physiological ventricular hypertrophy in response to exercise; 10 (all powerlifters) had interventricular septum thickness greater than 11 mm. Of the 27 participants with LV mass greater than 225 g and LV mass adjusted by BSA greater than 115g/m 2 , 13 (82%) were PG and 14 (63%) RG. Figure 1 shows FMD (%) and PVR measurements. Interestingly, FMD values were similar in both groups ([PG] 14.7 ± 2.3 vs. [RG] 15.9 ± 2.5%). However, PG had higher PVR values compared to RG ([PG] 12.6 ± 5.3 vs. [RG] 8.2 ± 3.8 mmHg/cm.s -1 , Δ35%). The correlations between training parameters and echocardiographic and cardiopulmonary variables in PG are displayed in Table 5. There was a direct correlation between interventricular septum thickness and weight load in the deadlift, squat, and total load. Interestingly, no correlation was found with time of exposure, i.e., duration in years of strength training among powerlifters. SBP levels were directly correlated with training intensity; and DBP showed a stronger correlation with duration of strength training. For runners, interventricular septum thickness and resting heart rate were inversely correlated with VO 2 max and duration of strength training (Table 6). Finally, FMD measurements were directly proportional to training intensity (% 1-RM) in PG and weight load for the squat (Table 7). For RG, no correlation of FMD values was found with cardiopulmonary variables and resting heart rate. Furthermore, FMD values were correlated with duration of powerlifting training (years) and daily duration of training session. However, this same correlation was not seen among runners. 12 774