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J Am Soc Echocardiogr. 2015 Dec;28(12):1434-40. doi: 10.1016/j.echo.2015.08.002. Epub 2015 Sep 9.

Endurance Exercise-Induced Cardiac Remodeling: Not All Sports Are Created Equal.

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Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts.
Harvard University Health Services, Cambridge, Massachusetts.
Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Health Services, Cambridge, Massachusetts. Electronic address:



The term endurance sport (ES) is broadly used to characterize any exercise that requires maintenance of high cardiac output over extended time. However, the relative amount of isotonic (volume) versus isometric (pressure) cardiac stress varies across ES disciplines. To what degree ES-mediated cardiac remodeling varies, as a function of superimposed isometric stress, is uncertain. The aim of this study was to compare the cardiac remodeling characteristics associated with two common yet physiologically distinct forms of ES.


Healthy competitive male long-distance runners (high isotonic, low isometric stress; n = 40) and rowers (high isotonic, high isometric stress; n = 40) were comparatively studied after 3 months of sport-specific exercise training with conventional and speckle-tracking two-dimensional echocardiography.


Rowers demonstrated dilated left ventricular (LV) volumes and elevated LV mass (i.e., eccentric LV hypertrophy), whereas runners demonstrated normal LV mass (runners, 88 ± 11 g/m(2); rowers, 108 ± 13 g/m(2); P < .001) despite comparatively larger LV volumes (runners, 101 ± 10 mL/m(2); rowers, 89 ± 13 mL/m(2); P < .001) consistent with eccentric LV remodeling. Increasing LV mass was associated with increased reliance on early diastolic filling (LV mass vs E'/A' ratio, R = 0.47, P < .001) indicating "mass-dependent" diastolic function. Right ventricular dilation of similar magnitude and LV systolic function, as assessed by numerous complementary indices, were similar in both groups.


Cardiac adaptations differ significantly as a function of ES discipline. Further work is required to determine the mechanisms for this differential adaptation, to develop definitive ES discipline-specific normative values, and to evaluate the optimal therapeutic use of specific ES disciplines among patients with common cardiovascular diseases.


Cardiac remodeling; Diastolic function; Endurance exercise; Left ventricular hypertrophy

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