Objectives: The long-term outcome and clinical significance of athlete’s heart has been debated and more longitudinal data are needed. We present a prospective 15 years’ follow-up study of ECG and echo findings in elite endurance athletes following the end of their competitive career. Methods: Clinical evaluation, ECG, ambulatory Holter recording and echocardiography were performed in 30 top-level endurance athletes with a mean age of 24 years with follow-up 15 years later. All had then ended their competitive career, but still performed recreational sports activities. Results: No clinical events were reported. Average resting heart rate was unchanged (53.5 ± 10 at baseline and 55.4 ± 11 at follow-up, p = n.s.), complex ventricular arrhythmias did not occur and the number of ventricular premature beats (VPBs) were 0.4 ± 0.8/h at baseline and 3.8 ± 10/h at follow-up (p = n.s.). In a subgroup of 4 subjects with >100 VPBs per hour at follow-up left ventricular mass was increased compared to the others (p < 0.03). Furthermore, regression of sino-atrial (SA) and atrioventricular (AV) blocks was shown. There were no cases of atrial flutter or fibrillation. There was a slight reduction in mean left ventricular wall thickness (9.9 ± 1.2 vs. 9.5 ± 1.4 mm, p < 0.05) and a highly significant reduction of relative wall thickness (0.38 vs. 0.35, p < 0.001). Left ventricular end-diastolic volume (68 ± 6 vs. 70 ± 7 ml ml/m2, p = n.s.) and left ventricular mass (109 ± 19 vs. 107 ± 19 g/m2, p = n.s.) were unchanged when corrected for body surface area and ejection fraction (EF) increased (60 ± 7 vs. 67 ± 6%, p < 0.01). Parameters of left ventricular diastolic function were normal both at baseline and follow-up. Conclusions: There was no evidence of deleterious cardiac effects of previous top-level endurance athletic activity at 15 years’ follow-up.

Henschen HE: Skilanglauf und Skiwettlauf. Eine medizinsche Sportstudie. Mitt Med Kin Uppsala. Jena, Fischer, 1899, vol 2, p 15.
Rost R: The athlete’s heart. Eur Heart J 1982;(suppl A)3:193–198.
Bjørnstad H, Storstein L, Dyre Meen H, Hals O: Ambulatory electrocardiographic findings in top athletes, athletic students and control subjects. Cardiology 1994;84:42–50.
Bjørnstad H, Smith G, Storstein L, Dyre Meen H, Hals O: Electrocardiographic findings in athletic students and sedentary controls. Cardiology 1991;79:290–305.
Bjørnstad H, Smith G, Storstein L, Dyre Meen H, Hals O: Electrocardiographic and echocardiographic findings in top athletes, athletic students, and sedentary controls. Cardiology 1993;82:66–74
Coumel P: Atrial fibrillation: one more sporting inconvenience (editorial)? Eur Heart J 2002;23:431–433.
McCann GP, Muir DF, Hillis WS: Athletic left ventricular hypertrophy: long-term studies are required (editorial). Eur Heart J 2000;21:351–353.
Thompson PD, Apple FS, Wu A: Marathoner’s heart (editorial)? Circulation 2006;114:2306–2308.
Task Force of the ESC and the NASPE: Heart rate variability: standards of measurement, physiological interpretation and clinical use. Eur Heart J 1996;17:354–381.
Sahn DJ, DeMaria A, Kisslo J, Weymann A: Recommendations regarding quantification in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978;58:1072–1083.
Teicholz IE, Kreulen T, Herman MV: Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 1976;37:7–11.
Devereux RB: Detection of left ventricular hypertrophy by M-mode echocardiography. Hypertension 1987;9(suppl II):II-19–26
Karvonen MJ: Effects of vigorous exercise on the heart. Clin Physiol 1959, pp 199–210.
Paffenbarger RS, Wing AL, Hyde RT: Physical activity as an index of heart attack risk in college alumni. J Epidemiol 1978;108:161–175.
Schnohr P: Logevity and causes of death in male athletic champions. Lancet 1971;1364–1367.
Beaglehole R, Stewart A: The longevity of international rugby players. NZ Med J 1983;96:513–515.
Polednak A: Longevity and cause of death among Harvard college athletes and their classmates. Geriatrics 1972;53–64.
Kujala UM, Kaprio J, Taimela S, Sarna S: Prevalence of diabetes, hypertension, and ischemic heart disease in former elite athletes. Metabolism 1994;43:1255–1260.
Pyorala K, Karvonen MJ, Taskinen P, Takkunen J, Kyronseppa H, Peltokallio P: Cardiovascular studies on former endurance athletes. Am J Cardiol 1967;20:191–205.
Ketelhut RG, Ketelhut K, Messerli FH, Badtke G: Fitness in the fit: does physical conditioning affect cardiovascular risk factors in middle-aged marathon runners? Eur Heart J 1996;17:199–203.
Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Aakhus K: Heart volume and cardiovascular mortality: a 16 year follow-up study of 1984 healthy middle-aged men. Eur Heart J 1993;14:592–596.
Lie H, Erikssen J: Five-year follow-up of ECG aberrations, latent coronary heart disease and cardiopulmonary fitness in various ages: groups of Norwegian cross country skiers. Acta Med Scand. 1984;216:377–383.
Rognmo Ø, Kahrs C, Bjørnstad TH, Bye A, Tjønna AE, Stølen T, Haram PH, Slørdal S, Wisløff U: Endothelial function in highly endurance-trained and sedentary young men: effects of aerobic exercise (abstract). Eur J Cardiovasc Prev Rehab 2006;13(suppl 1):S221.
Murayama M, Kuroda Y: Cardiovascular future of athletes. Sports Cardiol 1990;402–413.
Pelliccia A, Maron BJ, De Luca R, Di Paolo FM, Spataro A, Culasso F: Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation 2002;944–949.
Sivertssen E, Rykke E, Brekke M, Smith G: Er det farlig å drive toppidrett? En 25 års etterundersøkelse av 24 elitelangrennsløpere. Tidsskr Nor Lægeforen 1994;114:330–339.
van Ganse W, Versee L, Wylenbosch W, Vulsteek K: The electrocardiogram of athletes: comparison with untrained subjects. Br Heart J 1970;32:160–164.
Bjørnstad H, Storstein L, Meen HD, Hals O: Electrocardiographic findings of repolarization in athletic students and control subjects. Cardiology 1994;84:51–60.
Grimby G, Saltin B: Physiological analysis of physically well trained middle-aged and old athletes. Acta Med Scand 1966;179:513–526.
Roskamm H, Reindell H, Weissleder H, Kessler G, Aletter K: Zur Frage der Spätschäden nach intensivem Hochleistungssport. Med Welt 1964;2170–2180.
Holmgren A, Strandell T: The relationship heart volume, total hemoglobin and physical working capacity in former athletes. Acta Med Scand 1959;163:149–160.
Høglund C: Enlarged left atrial dimension in former endurance athletes: An echocardiographic study. Int J Sports Med 1986;7:133–136.
Baldesberger S, Bauersfeld U, Candinas R, Seifert B: Sinus node disease and arrhythmias in the long-term follow up of former professional cyclists. Eur Heart J 2008;29:71–78.
Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M: Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. BMJ 1998;316:1784–1785.
Mont L, Sambola A, Brugada J, Vacca M, Marrugat J, Elosua R, Pare C, Azqueta M, Sanz G: Long-lasting sport practice and lone atrial fibrillation. Eur Heart J 2002;23:477–482.
Heidbüchel H: High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias: role of an electrophysiologic study in risk stratification. Eur Heart J 2003;24:1473–1480.
Bjerregaard P: Premature beats in healthy subjects 40–79 years of age. Eur Heart J 1982;3:493–503.
Biffi A: Long-term clinical significance of complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 2002;40:446–452.
Miki T, Yokata Y, Toshihiko S, Yokoyama M: Echocardiographic findings in 104 professional cyclists with follow-up study. Am Heart J 1994;27:898–905.
Ogawa S, Tabata H, Ohishi S, Hitomi H, Shiomi H, Akita H, Haga H, Katsurada M: Prognostic significance of long ventricular pauses in athletes. Jpn Circ J 1991;55:761–766.
Caru B, Righetti G, Bossi M, Gerosa C, Gazzoti G, Maranetto D: Limits of cardiac functional adaptation in ‘top level’ resistance athletes. Ital Heart J 2001;2(suppl):150–154.
Sacknoff DM, Gleim G, Stachenfeld N, Coplan NL: Effect of athletic training on heart rate variability. Am Heart J 1994;127:1275–1278.
Hull SS, Vanolli E, Adamson PB, Verrier RL, Foreman RD, Scwartz P: Exercise training confers anticipatory protection from sudden death during acute myocardial ischemia. Circulation 1994;89:548–552.
Shapiro LM: Physiological left ventricular hypertrophy. Br Heart J 1984;52:130–135.
Fagard R, Aubert A, Lysens R, Staessen J, Vanhees L, Amery A: Noninvasive assessment of seasonal variations in cardiac structure and functions in cyclists. Circulation 1983;67:986–901.
Ehsani AA, Hagberg JM, Hickson RC: Rapid changes in left ventricular dimensions and mass in response to physical conditioning and deconditioning. Am J Cardiol 1978;42:52–56.
Takemoto KA, Bernstein L, Lopez JF, Marshak D, Rahimtoola SH, Chandraratna SH: Abnormalities of diastolic filling of the left ventricle associated with ageing are less pronounced in exercise-trained individuals. Am Heart J 1992;124:143–148.
Brenner DA, Apstein CS, Saupe KW: Exercise training attenuates age-associated diastolic dysfunction in rats. Circulation 2001;104:221–226.
Douillet R, Derumeaux G, Polin D, Jamal F, Troniou A, Cribier A: Differentiation of athletes physiological hypertrophy from hypertrophic cardiomyopathy by using pulsed Doppler issue imaging (abstract). Echocardiography 1998;15:S72.
Vinereanu D, Florescu N, Sculthorpe N, Tweddel AC, Stephens MR, Fraser AG: Differentiation between pathologic and physiologic left ventricular hypertrophy by tissue Doppler assessment of long-axis function in patients with hypertrophic cardiomyopathy or systemic hypertension and in athletes. Am J Cardiol 2001;88:53–58.
Nishimura T,Yamada Y, Kawai C: Echocardiographic evaluation of long-term effects of exercise on left ventricular hypertrophy and function in professional bicyclists. Circulation 1980;61:832–839.
Neilan TG, Januzzi JL, Lee-Lewandrowaki E, Than-Thao T-N, Yoerger DM, Jassal DS: Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston Marathon. Circulation 2006;114:2325–2333.
Badeer HS: The genesis of cardiomegaly in strenuous athletic training: a new look. J Sports Med Phys Fitness 1975;15:57–67.
Dickhuth HH, Reindell H, Lehmann M, Keul J: Rückbildungsfähigkeit des Sportherzens. Z Kardiol 1985;74(suppl 7):135–143.
Bouchard C, Boulay MC, Simoneau J-A, Lortie G, Perusse L: Heredity and trainability of aerobic and anaerobic performances: an update. Sports Med 1988;5:69–73.
Karjalainen J, Kujala UM, Stolt A, Mantysaari M, Viitasalo M, Kainulainen K, Kontula K: Angiotensinogen gene M235T polymorphism predicts left ventricular hypertrophy in endurance athletes. J Am Coll Cardiol 1999;34:494–499.
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