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Comparative Study
. 2016 Dec;9(12):1367-1376.
doi: 10.1016/j.jcmg.2016.07.013.

Blood Pressure and LV Remodeling Among American-Style Football Players

Jeffrey Lin  1 , Francis Wang  2 , Rory B Weiner  3 , James R DeLuca  1 , Meagan M Wasfy  1 , Brant Berkstresser  2 , Gregory D Lewis  1 , Adolph M Hutter Jr  1 , Michael H Picard  1 , Aaron L Baggish  4
Affiliations
Comparative Study

Blood Pressure and LV Remodeling Among American-Style Football Players

Jeffrey Lin et al. JACC Cardiovasc Imaging. 2016 Dec.

Abstract

Objectives: This study sought to determine the relationships among American-style football (ASF) participation, acquired left ventricular (LV) hypertrophy, and LV systolic function as assessed using contemporary echocardiographic parameters.

Background: Participation in ASF has been associated with development of hypertension and LV hypertrophy. To what degree these processes impact LV function is unknown.

Methods: This was a prospective, longitudinal cohort study evaluating National Collegiate Athletic Association Division I football athletes stratified by field position (linemen: n = 30; vs. nonlinemen, n = 57) before and after a single competitive season, using transthoracic echocardiography. LV systolic function was measured using complementary parameters of global longitudinal strain (GLS) (using 2-dimensional speckle-tracking) and ejection fraction (EF) (2-dimensional biplane).

Results: ASF participation was associated with field position-specific increases in systolic blood pressure (SBP) (a Δ SBP of 10 ± 8 mm Hg in linemen vs. a Δ SBP of 3 ± 7 mm Hg in nonlinemen; p < 0.001) and an overall increase in incident LV hypertrophy (pre-season = 8% vs. post-season = 25%, p < 0.05). Linemen who developed LV hypertrophy had concentric geometry (9 of 11 [82%]) with decreased GLS (Δ = -1.1%; p < 0.001), whereas nonlinemen demonstrated eccentric LV hypertrophy (8 of 10 [80%]) with increased GLS (Δ = +1.4%; p < 0.001). In contrast, LV ejection fraction in the total cohort, stratified by field position, was not significantly affected by ASF participation. Among the total cohort, lineman field position, post-season weight, SBP, average LV wall thickness, and relative wall thickness were all independent predictors of post-season GLS.

Conclusions: ASF participation at a lineman field position may lead to a form of sport-related myocardial remodeling that is pathologic rather than adaptive. Future study will be required to determine if targeted efforts to control blood pressure, minimize weight gain, and to include an element of aerobic conditioning in this subset of athletes may attenuate this process and translate into tangible downstream health benefits.

Keywords: athlete’s heart syndrome; hypertension; left ventricular function; left ventricular hypertrophy.

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Conflict of interest statement

Conflicts of Interest/Disclosures: None

Figures

Figure 1
Figure 1. Blood Pressure Among ASF Participants
Individual blood pressure (A) and categorical distribution of blood pressure status by Joint National Commission (seventh report) stage (B) stratified by field position before and after 90 days of American Style Football participation.
Figure 1
Figure 1. Blood Pressure Among ASF Participants
Individual blood pressure (A) and categorical distribution of blood pressure status by Joint National Commission (seventh report) stage (B) stratified by field position before and after 90 days of American Style Football participation.
Figure 2
Figure 2. Left Ventricular Systolic Function Among ASF Participants
Left ventricular systolic function as measured by ejection fraction (A) and global longitudinal strain (B) stratified by field position before and after 90 days of American Style Football participation. * = p<0.05 compared to preseason values.
See this image and copyright information in PMC

Comment in

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