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In our previous review characteristics of the athlete’s heart were divided into three groups: morphologic (left ventricular (LV) hypertrophy, improved coronary circulation), functional (better diastolic function) and regulatory (lower heart rate (HR)) features. In the present review, the influences of the types of sports and the age on the athlete’s heart are discussed. Studies using echocardiographic, Doppler-echocardiographic, tissue Doppler imaging (TDI) and magnetic resonance imaging (MRI) results are mostly involved. The coronary circulation was investigated overwhelmingly in animal experiments. In the LV hypertrophy a major contributor is the increase of the LV wall thickness (WT) than that of the LV internal diameter (ID). A right ventricular (RV) hypertrophy can also be seen in athletes. Athletic features are induced mostly by endurance training. Approximately two years regular physical training is needed to develop characteristics of the athlete’s heart, hence, in the young children they are less marked. LV hypertrophy and lower HR are characteristic in young and adult athletes, but they are less marked in older ones. A richer coronary capillary network can develop mostly at a young age.

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Authors: Zs. Major, E. Csajági, Zs. Kneffel, T. Kováts, I. Szauder, Z. Sidó and Gábor Pavlik

Characteristics of the athlete’s heart have been investigated mostly in the left ventricle (LV); reports referring to the right ventricle (RV) have only appeared recently. The aim of the present study was to compare the training effects on RV and LV in elite male endurance athletes. To this end, echocardiography was conducted in 52 elite endurance athletes (A) and in 25 non-athletes (NA). Differences between A and NA in the morphology was more marked in the RV (body-size-matched (rel.)) long axis diastolic diameter (RVLADd): 63.4 ± 6.3 vs. 56.4 ± 6.3; rel. short axis diastolic diameter (RVSADd): 27.3 ± 3.6 vs. 23.6 ± 2.7 mm/m, RV diastolic area 28 ± 5.0 vs. 21.3 ± 4.3 cm2 in all cases, p < 0.001) than in the LV (rel. LVLADd: 63.8 mm/m ± 5.6 vs. 60.7 mm/m ± 6.6, p < 0.05, rel.LVSADd 37.8 ± 3.1 vs. 35.3 ± 2.4, no difference). In the athletes ratios of peak early to late diastolic filling velocity (2.07 ± 0.51 vs. 1.75 ± 0.36, p < 0.01), the TDI-determined E’/A’ ratio in the septal (1.89 ± 0.55 vs. 1.62 ± 0.55, p < 0.05) and lateral (2.62 ± 0.72, vs. 2.18 ± 0.87, p < 0.001) walls were significantly higher than in NA only in the LV. Results indicate that in male endurance athletes morphologic adaptation is similar or slightly stronger in the RV than in the LV, functional adaptation seems to be stronger in the LV.

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Authors: Gábor Pavlik, Zs. Major, B. Varga-Pintér, M. Jeserich and Zs. Kneffel

Importance of the athlete’s heart has been arisen in the last decades.

  1. Consequences of the sedentary way of life are the most threatening through the impairments of the cardiovascular system. Endurance performance is mostly limited by the characteristics of the athlete’s heart. Sudden death of the athletes is always associated with cardiac disorders.
Main characteristics of the athlete’s heart can be divided into morphologic, functional and regulatory ones.
  1. The main morphologic characteristics are the physiologic left ventricular (LV) hypertrophy and a richer coronary capillary network. The functional adaptation contains a better systolic and diastolic function, modified metabolism and electric characteristics. The most easily detected modification is the better LV diastolic function. Adaptation of the cardiac regulation is manifested mostly by a lower heart rate (HR).
Summarizing: the athlete’s heart is an enlarged but otherwise normal heart characterized by a low heart rate, an increased pumping capacity, and a greater ability to deliver oxygen to skeletal muscle.

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Authors: Zs Major, R Kirschner, N Medvegy, K Kiss, GM Török, G Pavlik, G Simonyi, Zs Komka and M Medvegy


Early repolarization in the anterior ECG leads (ERV2–4) is considered to be a sign of right ventricular (RV) remodeling, but its etiology and importance are unclear.


A total of 243 top-level endurance-trained athletes (ETA; 183 men and 60 women, weekly training hours: 15–20) and 120 leisure-time athletes (LTA; 71 men and 49 women, weekly training hours: 5–6) were investigated. The ERV2–4 sign was evaluated concerning type of sport, gender, transthoracic echocardiographic parameters, and ECG changes, which can indicate elevated RV systolic pressure [left atrium enlargement (LAE), right atrium enlargement (RAE), RV conduction defect (RVcd)].


Stroke volume and left ventricular mass were higher in ETAs vs. LTAs in both genders (p < 0.01). Prevalence of the ERV2–4 sign was significantly higher in men than in women [p = 0.000, odds ratio (OR) = 36.4] and in ETAs than in LTAs (p = 0.000). The highest ERV2–4 prevalence appeared in the most highly trained triathlonists and canoe and kayak paddlers (OR = 13.8 and 5.2, respectively). Within the ETA group, the post-exercise LAE, RAE, and RVcd changes developed more frequently in cases with than without ERV2–4 (LAE: men: p < 0.05, females: p < 0.005; RAE: men: p < 0.05, females: p < 0.005; RVcd: N.S.). These post-exercise appearing LAE, RAE, and RVcd are associated with the ERV2–4 sign (OR = 4.0, 3.7, and 3.8, respectively).


According to these results, ERV2–4 develops mainly in male ETAs due to long-lasting and repeated endurance training. The ERV2–4 sign indicates RV’s adaptation to maintain higher compensatory pulmonary pressure and flow during exercise but its danger regarding malignant arrhythmias is unclear.

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Authors: Zsuzsanna Kneffel, B. Varga-Pintér, M. Tóth, Zs Major and G. Pavlik

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Authors: Zsolt Komka, E. Bosnyák, E. Trájer, A. Protzner, Zs. Major, G. Pavlik, M. Tóth and A. Udvardy


Sudden cardiac death (SCD) of athletes usually occurs during warm-up or shortly after training. At this point sympathetic tone is still elevated but oxygen demand does not differ from resting levels. It is supposed not to have a primarily ischemic origin but most likely relates to repolarization abnormalities which can be associated with intracellular cAMP level caused by increased sympathetic tone. The mediators of sympathetic nervous system are the catecholamines (epinephrin, norepinephrin). Measuring QT-dispersion can show the repolarization's inhomogeneity. 27 elite soccer players, 28 triathletes and 29 non-trained control person took part in our study. It was recorded cardiac ultrasound, an ECG and taken blood before and after exercise. We found significantly higher QT-dispersion and catecholamines in soccer players compared to the triathletes and the controls. However the soccer players did not show larger athlete's heart than the triathletes. After exercise the increased repolarization inhomogeneity persisted in soccer players, but in triathletes it decreased. Increased sympathetic tone in athletes can enhance arrhythmia propensity. Our data may explain why the soccer players die of sudden cardiac death most commonly in Europe.

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Authors: Gábor Skaliczki, M. Weszl, K. Schandl, T. Major, M. Kovács, J. Skaliczki, H. Redl, M. Szendrői, K. Szigeti, D. Máté, Cs Dobó-Nagy and Zs Lacza

Purpose: The clinical demand for bone grafting materials necessitated the development of animal models. Critical size defect model has been criticized recently, mainly for its inaccuracy. Our objective was to develop a dependable animal model that would provide compromised bone healing, and would allow the investigation of bone substitutes. Methods: In the first group a critical size defect was created in the femur of adult male Wistar rats, and a non-critical defect in the remaining animals (Groups II, III and IV). The defect was left empty in group II, while in groups III and IV a spacer was interposed into the gap. Osteoblast activity was evaluated by NanoSPECT/CT imaging system. New bone formation and assessment of a union or non-union was observed by μCT and histology. Results: The interposition model proved to be highly reproducible and provided a bone defect with compromised bone healing. Significant bone regeneration processes were observed four weeks after removal of the spacer. Conclusion: Our results have shown that when early bone healing is inhibited by the physical interposition of a spacer, the regeneration process is compromised for a further 4 weeks and results in a bone defect during the time-course of the study.

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