دانلود رایگان ترجمه مقاله قلب ورزشکاران استقامتی و استرس حاد – Bjsm 2012

قلب ورزشکاران استقامتی: استرس حاد و تطبیق مزمن

The endurance athletes heart: acute stress and chronic adaptation

Abstract

The impact of endurance exercise training on the heart has received significant research and clinical attention for well over a century. Despite this, many issues remain controversial and clinical interpretation can be complex of biomarkers of cardiomyocyte insult. This review assesses the current state of knowledge related to two areas of research where problems with clinical decision making may arise: (1) the impact of chronic endurance exercise training on cardiac structure, function and electrical activity to the point where the athletic heart phenotype may be similar to the expression of some cardiac pathologies (a diagnostic dilemma referred to as the ‘greyzone’) and (2) the impact of acute bouts of prolonged exercise on cardiac function and the presentation of biomarkers and cardiomyocyte insult in the circulatory system. The combination of acute endurance exercise stress on the heart and prolonged periods of training are considered together in the final section.

1 Introduction

Endurance athletes perform significant volumes of exercise training. This training places a substantial demand on the heart that acts as a physiological and metabolic stimulus for adaptation in cardiac muscle. The clinical relevance of cardiac changes with endurance exercise can be reviewed in three broad areas: (1) how does heart structure, function or electrical activity adapt to endurance training? (2) Are there any consequences for cardiac function and cardiomyocyte integrity that arise from undertaking acute bouts of (ultra)endurance exercise? (3) What, if any, clinically relevant cardiac changes can be observed in endurance athletes if lifelong endurance exercise can be documented? These questions are relevant and are reflected in recent case studies1 and case–control series2 as well as reviews.3–5 The following review seeks to summarise and clinically contextualise the historical database, emerging data, controversies and clinical quandaries as well as to direct future research.