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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The expression &#8216;athlete&#39;s heart&#8217; describes the physiological adaptations &#8211; morphological&#44; functional and electrical &#8211; of the heart to physical activity&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The phenotypic expression of athlete&#39;s heart is known to be influenced by several factors&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> including body size &#40;body surface area&#44; fat-free mass&#44; and height&#41;&#44; gender&#44; ethnicity and age&#46; Together with these demographic factors&#44; cardiac adaptations to exercise also depend on the type&#44; intensity&#44; and cumulative duration of training protocols&#44; with a dose-effect relationship &#40;more than 10-15 hours per week of exercise usually being associated with cardiac remodeling&#41;&#46; The hemodynamic overload caused by training is always characterized by a harmonious and consistent increase in the dimensions of all cardiac chambers&#44; while a disproportionate increase suggests a pathological process&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Almost half a century ago&#44; Morganroth et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> proposed that the morphological adaptations of the heart in athletes result from the type of hemodynamic overload imposed during exercise&#46; According to this hypothesis&#44; dynamic&#44; endurance &#40;isotonic&#41; exercise would&#44; as a consequence of volume overload&#44; lead to eccentric left ventricular &#40;LV&#41; hypertrophy &#40;LVH&#41; &#40;LV mass increase with increased LV cavity size&#41;&#46; By contrast&#44; static&#44; strength &#40;isometric&#41; training would&#44; as a consequence of pressure overload&#44; cause concentric LVH &#40;increased wall thickness with no change in cavity size&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Since then&#44; the &#8216;Morganroth hypothesis&#8217; has been challenged and tested in several cross-sectional studies&#46; While these studies have in many cases supported the hypothesis for endurance training&#44; they have failed to confirm it in strength sports&#46; This may&#44; at least in part&#44; be explained by the fact that in the real world&#44; many supposedly purely isotonic sports in fact simultaneously involve both types of exercise to a similar extent&#44; leading to mixed remodeling patterns&#46; On the other hand&#44; strength exercise often consists of sequential short bursts of intensive exertion and pressure overload&#44; with relatively short cumulative duration&#46; Other possible explanations include the lack of standardized measurements&#44; the inaccuracy of M-mode and two-dimensional echocardiographic measurements&#44; and the confounding effect of performance-enhancing substances&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ideally&#44; the Morganroth hypothesis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> should be retested in longitudinal studies&#44; using well-defined exercise protocols and standardized measurements&#44; with cardiac magnetic resonance imaging &#40;CMRI&#41; and&#47;or three-dimensional &#40;3D&#41; echocardiography&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>&#44; Dinis et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> in a prospective case-control study using echocardiography&#44; compare the impact of exercise training in athletes and in soldiers undergoing special forces training&#46; They showed that while the soldiers showed a predominantly eccentric remodeling pattern&#44; in athletes the pattern was essentially concentric&#46; The authors postulate that the intensity and duration of training and specific characteristics of the training programs might explain the different remodeling patterns found&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The soldiers received higher-intensity training than the athletes&#44; with greater cumulative duration&#44; and greater preload and volume overload&#44; leading to eccentric remodeling&#46; The athletes&#44; with moderate-intensity exercise and less cumulative duration&#44; developed concentric remodeling as a response to pressure overload&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The authors thus partially confirm the Morganroth hypothesis&#44; explaining that the morphological adaptations of the heart in athletes result from the type of hemodynamic overload imposed during exercise&#46; However&#44; according to them&#44; and contradicting Morganroth&#44; it is not the type of exercise&#44; so statically defined by Morganroth&#44; but the cumulative amount and intensity of exercise in the training program &#40;a pattern of phases over time&#41; that in real life determines the predominant remodeling pattern&#44; as suggested in a previous small longitudinal study with a relatively long follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As stated above&#44; the time-honored &#8216;Morganroth hypothesis&#8217; should be retested in longitudinal studies&#44; using well-defined exercise protocols and standardized measurements&#44; with CMRI and&#47;or 3D echocardiography&#46; However&#44; the study by Dinis et al&#46; does not fulfill all these criteria&#59; although the study was longitudinal&#44; the exercise protocols were not defined by the researchers&#44; so they should have been more precisely controlled for&#59; furthermore&#44; neither CMRI nor 3D echocardiography was used&#59; finally&#44; their follow-up was too short&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding athlete&#39;s heart and soldier&#39;s heart&#44; it is not the quality &#40;the type of sport&#41; but the quantity &#40;duration and intensity of exercise&#41; that matters&#46; Is Morganroth striking back&#63; To be confirmed&#8230;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Editorial comment
Athlete's heart and soldier's heart: Is Morganroth striking back?
O coração dos atletas e dos militares: está Morganroth a contra-atacar?
Nuno Cardim
Cardiac Multimodality Imaging Department, Hospital da Luz, Lisbon, Portugal
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    "titulo" => "Athlete&#39;s heart and soldier&#39;s heart&#58; Is Morganroth striking back&#63;"
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        "titulo" => "O cora&#231;&#227;o dos atletas e dos militares&#58; est&#225; Morganroth a contra-atacar&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The expression &#8216;athlete&#39;s heart&#8217; describes the physiological adaptations &#8211; morphological&#44; functional and electrical &#8211; of the heart to physical activity&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The phenotypic expression of athlete&#39;s heart is known to be influenced by several factors&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> including body size &#40;body surface area&#44; fat-free mass&#44; and height&#41;&#44; gender&#44; ethnicity and age&#46; Together with these demographic factors&#44; cardiac adaptations to exercise also depend on the type&#44; intensity&#44; and cumulative duration of training protocols&#44; with a dose-effect relationship &#40;more than 10-15 hours per week of exercise usually being associated with cardiac remodeling&#41;&#46; The hemodynamic overload caused by training is always characterized by a harmonious and consistent increase in the dimensions of all cardiac chambers&#44; while a disproportionate increase suggests a pathological process&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Almost half a century ago&#44; Morganroth et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> proposed that the morphological adaptations of the heart in athletes result from the type of hemodynamic overload imposed during exercise&#46; According to this hypothesis&#44; dynamic&#44; endurance &#40;isotonic&#41; exercise would&#44; as a consequence of volume overload&#44; lead to eccentric left ventricular &#40;LV&#41; hypertrophy &#40;LVH&#41; &#40;LV mass increase with increased LV cavity size&#41;&#46; By contrast&#44; static&#44; strength &#40;isometric&#41; training would&#44; as a consequence of pressure overload&#44; cause concentric LVH &#40;increased wall thickness with no change in cavity size&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Since then&#44; the &#8216;Morganroth hypothesis&#8217; has been challenged and tested in several cross-sectional studies&#46; While these studies have in many cases supported the hypothesis for endurance training&#44; they have failed to confirm it in strength sports&#46; This may&#44; at least in part&#44; be explained by the fact that in the real world&#44; many supposedly purely isotonic sports in fact simultaneously involve both types of exercise to a similar extent&#44; leading to mixed remodeling patterns&#46; On the other hand&#44; strength exercise often consists of sequential short bursts of intensive exertion and pressure overload&#44; with relatively short cumulative duration&#46; Other possible explanations include the lack of standardized measurements&#44; the inaccuracy of M-mode and two-dimensional echocardiographic measurements&#44; and the confounding effect of performance-enhancing substances&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ideally&#44; the Morganroth hypothesis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> should be retested in longitudinal studies&#44; using well-defined exercise protocols and standardized measurements&#44; with cardiac magnetic resonance imaging &#40;CMRI&#41; and&#47;or three-dimensional &#40;3D&#41; echocardiography&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>&#44; Dinis et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> in a prospective case-control study using echocardiography&#44; compare the impact of exercise training in athletes and in soldiers undergoing special forces training&#46; They showed that while the soldiers showed a predominantly eccentric remodeling pattern&#44; in athletes the pattern was essentially concentric&#46; The authors postulate that the intensity and duration of training and specific characteristics of the training programs might explain the different remodeling patterns found&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The soldiers received higher-intensity training than the athletes&#44; with greater cumulative duration&#44; and greater preload and volume overload&#44; leading to eccentric remodeling&#46; The athletes&#44; with moderate-intensity exercise and less cumulative duration&#44; developed concentric remodeling as a response to pressure overload&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The authors thus partially confirm the Morganroth hypothesis&#44; explaining that the morphological adaptations of the heart in athletes result from the type of hemodynamic overload imposed during exercise&#46; However&#44; according to them&#44; and contradicting Morganroth&#44; it is not the type of exercise&#44; so statically defined by Morganroth&#44; but the cumulative amount and intensity of exercise in the training program &#40;a pattern of phases over time&#41; that in real life determines the predominant remodeling pattern&#44; as suggested in a previous small longitudinal study with a relatively long follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As stated above&#44; the time-honored &#8216;Morganroth hypothesis&#8217; should be retested in longitudinal studies&#44; using well-defined exercise protocols and standardized measurements&#44; with CMRI and&#47;or 3D echocardiography&#46; However&#44; the study by Dinis et al&#46; does not fulfill all these criteria&#59; although the study was longitudinal&#44; the exercise protocols were not defined by the researchers&#44; so they should have been more precisely controlled for&#59; furthermore&#44; neither CMRI nor 3D echocardiography was used&#59; finally&#44; their follow-up was too short&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding athlete&#39;s heart and soldier&#39;s heart&#44; it is not the quality &#40;the type of sport&#41; but the quantity &#40;duration and intensity of exercise&#41; that matters&#46; Is Morganroth striking back&#63; To be confirmed&#8230;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2018.03.003
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en pt

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.