Determinants and Physiological Limits of Cardiac Morphologic Adaptation in Elite Athletes

  • A. Pelliccia
  • A. Spataro
  • F. M. Di Paolo


Morphologic cardiac adaptation induced by athletic conditioning (athlete’s heart) has been recognized since the late century and to date, a large number of studies have described the morphologic features of the hearts of a variety of athletes engaged in different athletic disciplines [1–11]. However, some aspects of athlete’s heart are still topics of scientific interest, such as the physiological limits of morphological changes and the criteria of its differentiation from cardiovascular disease [12].


Elite Athlete Physiological Limit Left Ventricular Cavity Cross Country Skiing Left Ventricular Wall Thickness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Morganroth J, Maron BJ, Henry WL, Epstein SE (1975) Comparative left ventricular dimensions in trained athletes. Ann Intern Med 82:521–524PubMedCrossRefGoogle Scholar
  2. 2.
    Roeske WR, O’Rourke RA, Klein A, Leopold G, Karliner JS (1976) Noninvasive evaluation of ventricular hypertrophy in professional athletes. Circulation 53:286–292PubMedCrossRefGoogle Scholar
  3. 3.
    Ikaheimo MJ, Palatsi IJ, Takkunen JT (1979) Noninvasive evaluation of the athletic heart: sprinters versus endurance runners. Am J Cardiol 44:24–30PubMedCrossRefGoogle Scholar
  4. 4.
    Longhurst JC, Kelly AR, Gonyea WJ, Mitchell JH (1980) Echocardiographic left ventricular masses in distance runners and weight lifters. J Appl Physiol 48:154–162PubMedGoogle Scholar
  5. 5.
    Keul J, Dickuth HH, Simon G, Lehmann M (1981) Effect of static and dynamic exercise on heart volume, contractility, and left ventricular dimensions. Circ Res (Suppl I) 48:I-162-I-170Google Scholar
  6. 6.
    Ricci G, Lajoie D, Petitclerc R, Peronnet F, Ferguson R J, Fournier M, Taylor A W (1982) Left ventricular size following endurance, sprint and strength training. Med Sci Sports Exerc 14:344–347PubMedGoogle Scholar
  7. 7.
    Fagard R, Aubert A, Lysens R, Staessen J, Vanhees L, Amery A (1983) Noninvasive assessment of seasonal variations in cardiac structure and function in cyclists. Circulation 67:896–901PubMedCrossRefGoogle Scholar
  8. 8.
    Fagard R, Aubert A, Staessen J, Van den Eynde E, Vanhees L, Amery A (1984) Cardiac structure and function in cyclists and runners. Comparative echocardiographic study. Br Heart J 52:124–129PubMedCrossRefGoogle Scholar
  9. 9.
    Maron BJ (1986) Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol 7:190–203PubMedCrossRefGoogle Scholar
  10. 10.
    Van Den Broeke C, Fagard R (1988) Left ventricular structure and function, assessed by imaging and doppler echocardiography, in athletes engaged in throwing events. Int J Sports Med 9:407–411PubMedCrossRefGoogle Scholar
  11. 11.
    Fisher AG, Adame TD, Yahowitz FG, Ridges JD, Orsmond G, Nelson AG (1989) Noninvasive evaluation of world class athletes engaged in different modes of training. Am J Cardiol 63:337–341PubMedCrossRefGoogle Scholar
  12. 12.
    Maron BJ, Pelliccia A, Spirito P (1995) Cardiac disease in young trained athletes: insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 91:1596–1601PubMedCrossRefGoogle Scholar
  13. 13.
    Astrand PO (1956) Human physical fitness with special reference to sex and age. Physiol Rew 36:307–335Google Scholar
  14. 14.
    Gardin JM, Savage DD, Ware JH, Henry WL (1987) Effect of age, sex, body surface area on echocardiographic left ventricular wall mass in normal subjects. Hypertension (Suppl II) 9:II-36-II-39Google Scholar
  15. 15.
    Henry WL, Gardin JM, Ware JH (1980) Echocardiographic measurements in normal subjects from infancy to old age. Circulation 62:1054–1061PubMedCrossRefGoogle Scholar
  16. 16.
    Spirito P, Pelliccia A, Proschan M, Granata M, Spataro A, Bellone P, Caselli G, Biffi A, Vecchio C, and Maron BJ (1994) Morphology of the “athlete’s heart” assessed by echocardiography in 947 elite athletes representing 27 sports. Am J Cardiol 74:802–806PubMedCrossRefGoogle Scholar
  17. 17.
    Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P( 1991) The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 324:295–301PubMedCrossRefGoogle Scholar
  18. 18.
    Ehsani AA, Hagberg JM, Hickson RC (1978) Rapid changes in left ventricular dimensions and mass in response to physical conditioning and deconditioning. Am T Cardiol 42:52–56CrossRefGoogle Scholar
  19. 19.
    Martin WHIII, Coyle EF, Bloomfield SA, Enshani AA (1986) Effects of physical deconditioning after intense endurance training on left ventricular dimensions and stroke volume. J Am Coll Cardiol 7:982–989PubMedCrossRefGoogle Scholar
  20. 20.
    Maron BJ, Pelliccia A, Spataro A, Granata M (1993) Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. Br Heart J 69:125–128PubMedCrossRefGoogle Scholar
  21. 21.
    Pelliccia A, Spataro A, Caselli G, and Maron BJ (1993) Absence of left ventricular wall thickening in athletes engaged in intense power training. Am J Cardiol 72:1048–1054PubMedCrossRefGoogle Scholar
  22. 22.
    Ekblom P, Hermannsen L (1968) Cardiac output in athletes. J Appl Physiol 25:1968–1973Google Scholar
  23. 23.
    Palatini P, Mos L, Di Marco A, Mormino P, Munari L, Del Torre M, Valle F, Pessina AC, Dal Pala C (1987) Intra-arterial blood pressure recording during sports activities. J Hypertens 5 (Suppl 5):479–484Google Scholar
  24. 24.
    MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR (1985) Arterial blood pressure response to heavy resistance exercise. J Appl Physiol 58:785–790PubMedGoogle Scholar
  25. 25.
    MacDougall JD, McKelvie RS, Moroz DE, Sale DG, McCartney N, Buick F (1992) Factors affecting blood pressure during heavy weight lifting and static contractions. J Appl Physiol 73:1590–1597PubMedGoogle Scholar
  26. 26.
    Tumilty D (1993) Physiological characteristics of elite soccer players. Sports Med 16:80–96PubMedCrossRefGoogle Scholar
  27. 27.
    Granata M, Danese M, Ziantoni P (1990) Heart rate recording in the riders and horses during training and three-day events official competition. In: Sports, Medicine and Hralth. Proceedings of XXIV World Congress of Sports Medicine. Excerpta Medica pp 1010–1014Google Scholar
  28. 28.
    Epstein M, Goldberg SJ, Allen HD, Konecke L, Wood J (1975) Great vessels, cardiac chamber and wall growth patterns in normal children. Circulation 67:1124–1129CrossRefGoogle Scholar
  29. 29.
    Devereux RB, Lutas EM, Casale PN, Kligfield P, Eisenberg RR, Hammond IW, Miller DH, Reis G, Alderman MH, Laragh JH (1984) Standardization of M-mode echocardiorahic left ventricular anatomic measurements. J Am Coll Cardiol 4:1222–1230PubMedCrossRefGoogle Scholar
  30. Lamont LS (1980) Effects of training on echocardiographic dimensions and systolic time intervals in women swimmers. J Sports Med 20:397–404Google Scholar
  31. 31.
    Falsetti H, Gisolfi C, Lemon D, Cohen J, Claxton B, Cramer JA, Lenth RA (1982) Noninvasive evaluation of left ventricular function in trained bicyclists. J Sports Med 22:199–206Google Scholar
  32. 32.
    Crouse SF, Rohack JJ, Jacobsen DJ (1992) Cardiac structure and function in women basketball athletes: seasonal variation and comparisons with nonathletic controls. Res Q Exerc Sports 63:393–401CrossRefGoogle Scholar
  33. 33.
    Pelliccia A, Maron BJ, Spataro A, Biffi A, Caselli G, Culasso F (1996) Physiological limits of athlete’s heart in women. Jama 276:211–215PubMedCrossRefGoogle Scholar
  34. 34.
    Zwiren LD, Cureton KJ, Hutchinson P (1983) Comparison of circulatory responses to submaximal exercise in equally trained men and women. Int J Sports Med 4:255–259PubMedCrossRefGoogle Scholar
  35. 35.
    Higginbotham MB, Morris KG, Coleman E, Cobb R (1984) Sex-related differences in the normal cardiac response to upright exercise. Circulation 70:357–366PubMedCrossRefGoogle Scholar
  36. 36.
    Mitchell JH, Tate C, Raven P (1992) Acute responses and chronic adaptation to exercise in women. Med Sci Sports Exerc 24 (Suppl):S 258-S 265Google Scholar
  37. 37.
    Gleim GW, Stachenfeld NS, Coplan NL, Nicholas JA (1991) Gender differences in the systolic blood pressure response to exercise. Am Heart J 121:524–530PubMedCrossRefGoogle Scholar
  38. 38.
    Wieling W, Borghols EAM, Hollander AP, Danner SA, Dunning AJ (1981) Echocardiographic dimensions and maximal oxygen uptake in oarsmen during training. Br Heart J 46:190–195PubMedCrossRefGoogle Scholar
  39. 39.
    Adams TD, Yanowitz FG, Fisher AG, Ridges JD, Nelson AG, Hagan AD, Williams RR, Hunt SC (1985) Heritability of cardiac size: an echocardiographic and electrocardiographic study of monozygotic and dizygotic twins. Circulation 71:39–44PubMedCrossRefGoogle Scholar
  40. 40.
    Fagard R, Van Den Broeke C, Bielen E, Amery A (1987) Maximum oxygen uptake and cardiac size and function in twins. Am J Cardiol 60:1362–1367PubMedCrossRefGoogle Scholar
  41. 41.
    Pelliccia A, Maron BJ, Culasso F, Spataro A, Caselli G (1994) Upper limits of physiologically induced left ventricular cavity enlargement due to athletic training. (Abstr) Circulation 90:I-165Google Scholar

Copyright information

© Springer-Verlag Italia 1997

Authors and Affiliations

  • A. Pelliccia
    • 1
  • A. Spataro
    • 1
  • F. M. Di Paolo
    • 1
  1. 1.Department of MedicineInstitute of Sport SciencesRomeItaly

Personalised recommendations