Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation

doi:10.3390/jcdd9120438

Review

. 2022 Dec 6;9(12):438.

doi: 10.3390/jcdd9120438.

Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation

Viswanath B Unnithan¹, Alexander Beaumont², Thomas Rowland¹, Keith George³, Nicholas Sculthorpe¹, Rachel N Lord⁴, Andisheh Bakhshi⁵, David Oxborough³

Affiliations

¹ Sport and Physical Activity Research Institute, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton G72 0LH, UK.
² School of Science, Technology and Health, York St. John University, York YO31 7EX, UK.
³ Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK.
⁴ Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
⁵ Phastar, Glasgow, Scotland, UK.

PMID: 36547435
PMCID: PMC9787332
DOI: 10.3390/jcdd9120438

Review

Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation

Viswanath B Unnithan et al. J Cardiovasc Dev Dis. 2022.

. 2022 Dec 6;9(12):438.

doi: 10.3390/jcdd9120438.

Authors

Viswanath B Unnithan¹, Alexander Beaumont², Thomas Rowland¹, Keith George³, Nicholas Sculthorpe¹, Rachel N Lord⁴, Andisheh Bakhshi⁵, David Oxborough³

Affiliations

¹ Sport and Physical Activity Research Institute, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton G72 0LH, UK.
² School of Science, Technology and Health, York St. John University, York YO31 7EX, UK.
³ Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK.
⁴ Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
⁵ Phastar, Glasgow, Scotland, UK.

PMID: 36547435
PMCID: PMC9787332
DOI: 10.3390/jcdd9120438

Abstract

There is an increase in the prevalence of elite youth sports academies, whose sole aim is to develop future elite athletes. This involves the exposure of the child and adolescent athlete to high-volume training during a period of volatile growth. The large amount of data in this area has been garnered from the resting echocardiographic left ventricular (LV) evaluation of the youth athlete; while this can provide some insight on the functional adaptations to training, it is unable to elucidate a comprehensive overview of the function of the youth athletes' LV during exercise. Consequently, there is a need to interrogate the LV responses in-exercise. This review outlines the feasibility and functional insight of capturing global indices of LV function (Stroke Index-SVIndex and Cardiac Index-QIndex), systolic and diastolic markers, and cardiac strain during submaximal and maximal exercise. Larger SVI and QI were noted in these highly trained young athletes compared to recreationally active peers during submaximal and maximal exercise. The mechanistic insights suggest that there are minimal functional systolic adaptions during exercise compared to their recreationally active peers. Diastolic function was superior during exercise in these young athletes, and this appears to be underpinned by enhanced determinants of pre-load.

Keywords: echocardiography; highly trained; in-exercise; youth athletes.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

**Figure 1**
Stroke index (a) and cardiac index (b) at rest and during submaximal and maximal exercise in the child cyclists and untrained children. Difference between workloads for both groups (* p < 0.05 and ** p < 0.001). Difference between the child cyclists and the untrained children († p < 0.01 and †† p < 0.001). Nottin et al., 2002 [34]. Reprinted with permission from Nottin et al. [34], 2002, John Wiley and Sons.

**Figure 2**
QIndex responses of soccer players (n = 22) and controls (n = 15) at the two comparable, relative exercise intensities (RE (1) and RE (2)). The symbols denote the mean values. Horizontal error bars denote the variability (SD) in relative exercise intensity (%VO₂max) and vertical error bars denote the variability (SD) in QIndex. At both RE (1) and RE (2), the SP demonstrated significantly greater QIndex responses than the CON. * denotes p ≤ 0.05. Unnithan et al., 2018 [33]. Reprinted with permission from Unnithan et al. [33], 2018, John Wiley and Sons.

**Figure 3**
SVIndex responses of soccer players (n = 22) and controls (n = 15) at the two comparable, relative exercise intensities (RE (1) and RE (2)). The symbols denote the mean values. Horizontal error bars denote the variability (SD) in relative exercise intensity (%VO₂max) and vertical error bars denote the variability (SD) in SVIndex. At RE (1), the SP demonstrated significantly greater SVIndex responses than the CON. There was no significant inter-group difference in SVIndex at RE (2). * denotes p ≤ 0.05. Unnithan et al. [33]. Reprinted with permission from Unnithan et al. [33], 2018, John Wiley and Sons.

**Figure 4**
Changes in heart rate (HR), cardiac index (QIndex), stroke volume index (SVIndex), and arterial-venous oxygen difference (AVO₂ difference) at approximately 45% $\dot{V} O_{2 p e a k}$ in the control participants and soccer players over the course of the three-year observational study. All values are median and inter-quartile range. Unnithan et al. [1]. Reprinted with permission from Unnithan et al. [1], 2022, John Wiley and Sons.

**Figure 5**
Changes in TDI derived markers of systolic (peak aortic velocity and S′adj) and diastolic function (E, E′adj and E/E′) during submaximal exercise at approximately 45% $\dot{V} O_{2 p e a k}$ in the control participants and soccer players over the course of the three-year observational study. All values are median and inter-quartile range. Unnithan et al. 2022 [1]. Reprinted with permission from Unnithan et al. [1], 2022, John Wiley and Sons.

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References

1. Unnithan V.B., Rowland T., George K., Bakhshi A., Beaumont A., Sculthorpe N., Lord R.N., Oxborough D.L. Effect of Long-term Soccer Training on Changes in Cardiac Function during Exercise in Elite Youth Soccer Players. Scand J. Med. Sci. Sport. 2022;32:892–902. doi: 10.1111/sms.14140. - DOI - PubMed
1. Lloyd R.S., Oliver J.L. The Youth Physical Development Model: A New Approach to Long-Term Athletic Development. Strength Cond. J. 2012;34:61–72. doi: 10.1519/SSC.0b013e31825760ea. - DOI
1. McClean G., Riding N.R., Ardern C.L., Farooq A., Pieles G.E., Watt V., Adamuz C., George K.P., Oxborough D., Wilson M.G. Electrical and Structural Adaptations of the Paediatric Athlete’s Heart: A Systematic Review with Meta-Analysis. Br. J. Sports Med. 2017;52:230–242. doi: 10.1136/bjsports-2016-097052. - DOI - PubMed
1. La Gerche A., Baggish A.L., Knuuti J., Prior D.L., Sharma S., Heidbuchel H., Thompson P.D. Cardiac Imaging and Stress Testing Asymptomatic Athletes to Identify Those at Risk of Sudden Cardiac Death. JACC Cardiovasc. Imaging. 2013;6:993–1007. doi: 10.1016/j.jcmg.2013.06.003. - DOI - PubMed
1. Sanz-de la Garza M., Giraldeau G., Marin J., Grazioli G., Esteve M., Gabrielli L., Brambila C., Sanchis L., Bijnens B., Sitges M. Influence of Gender on Right Ventricle Adaptation to Endurance Exercise: An Ultrasound Two-Dimensional Speckle-Tracking Stress Study. Eur. J. Appl. Physiol. 2017;117:389–396. doi: 10.1007/s00421-017-3546-8. - DOI - PubMed

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[1] Unnithan V.B., Rowland T., George K., Bakhshi A., Beaumont A., Sculthorpe N., Lord R.N., Oxborough D.L. Effect of Long-term Soccer Training on Changes in Cardiac Function during Exercise in Elite Youth Soccer Players. Scand J. Med. Sci. Sport. 2022;32:892–902. doi: 10.1111/sms.14140. - DOI - PubMed

[2] Unnithan V.B., Rowland T., George K., Bakhshi A., Beaumont A., Sculthorpe N., Lord R.N., Oxborough D.L. Effect of Long-term Soccer Training on Changes in Cardiac Function during Exercise in Elite Youth Soccer Players. Scand J. Med. Sci. Sport. 2022;32:892–902. doi: 10.1111/sms.14140. - DOI - PubMed

[3] Lloyd R.S., Oliver J.L. The Youth Physical Development Model: A New Approach to Long-Term Athletic Development. Strength Cond. J. 2012;34:61–72. doi: 10.1519/SSC.0b013e31825760ea. - DOI

[4] Lloyd R.S., Oliver J.L. The Youth Physical Development Model: A New Approach to Long-Term Athletic Development. Strength Cond. J. 2012;34:61–72. doi: 10.1519/SSC.0b013e31825760ea. - DOI

[5] McClean G., Riding N.R., Ardern C.L., Farooq A., Pieles G.E., Watt V., Adamuz C., George K.P., Oxborough D., Wilson M.G. Electrical and Structural Adaptations of the Paediatric Athlete’s Heart: A Systematic Review with Meta-Analysis. Br. J. Sports Med. 2017;52:230–242. doi: 10.1136/bjsports-2016-097052. - DOI - PubMed

[6] McClean G., Riding N.R., Ardern C.L., Farooq A., Pieles G.E., Watt V., Adamuz C., George K.P., Oxborough D., Wilson M.G. Electrical and Structural Adaptations of the Paediatric Athlete’s Heart: A Systematic Review with Meta-Analysis. Br. J. Sports Med. 2017;52:230–242. doi: 10.1136/bjsports-2016-097052. - DOI - PubMed

[7] La Gerche A., Baggish A.L., Knuuti J., Prior D.L., Sharma S., Heidbuchel H., Thompson P.D. Cardiac Imaging and Stress Testing Asymptomatic Athletes to Identify Those at Risk of Sudden Cardiac Death. JACC Cardiovasc. Imaging. 2013;6:993–1007. doi: 10.1016/j.jcmg.2013.06.003. - DOI - PubMed

[8] La Gerche A., Baggish A.L., Knuuti J., Prior D.L., Sharma S., Heidbuchel H., Thompson P.D. Cardiac Imaging and Stress Testing Asymptomatic Athletes to Identify Those at Risk of Sudden Cardiac Death. JACC Cardiovasc. Imaging. 2013;6:993–1007. doi: 10.1016/j.jcmg.2013.06.003. - DOI - PubMed

[9] Sanz-de la Garza M., Giraldeau G., Marin J., Grazioli G., Esteve M., Gabrielli L., Brambila C., Sanchis L., Bijnens B., Sitges M. Influence of Gender on Right Ventricle Adaptation to Endurance Exercise: An Ultrasound Two-Dimensional Speckle-Tracking Stress Study. Eur. J. Appl. Physiol. 2017;117:389–396. doi: 10.1007/s00421-017-3546-8. - DOI - PubMed

[10] Sanz-de la Garza M., Giraldeau G., Marin J., Grazioli G., Esteve M., Gabrielli L., Brambila C., Sanchis L., Bijnens B., Sitges M. Influence of Gender on Right Ventricle Adaptation to Endurance Exercise: An Ultrasound Two-Dimensional Speckle-Tracking Stress Study. Eur. J. Appl. Physiol. 2017;117:389–396. doi: 10.1007/s00421-017-3546-8. - DOI - PubMed

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Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation

Affiliations

Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Cited by

References

Publication types

Grants and funding

LinkOut - more resources

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