Left ventricular remodeling in elite athletes.

To the Editor: Pellicchia et al1 should be congratulated for their unique database and their recent paper on ventricular remodeling after cessation of competitive sports in elite athletes. Their conclusion that ventricular cavity size and wall thickness decreased in all athletes after detraining is consistent with reports in previous longitudinal studies.2,3 However, their observation that ventricular size does not completely normalize should be further qualified by data that were not clearly reported in the article. The spread of 1 to 13 years for the interval between cessation of exercise and the reported follow-up measurement may be the greatest confounder of these results. Given that short-term training followed by cessation is associated with normalization of ventricular dimensions,2,3 it is reasonable to expect that long-term cumulative changes may regress more slowly. Could it be that the athletes closest to detraining were the ones with persistent cavity enlargement? Furthermore, the duration of performance at elite levels prior to commencement of detraining cannot be gleaned from the report. Athletes with several years of training could be expected to have a bigger left ventricular cavity than those with less training, and therefore require a longer detraining observation period before cavity size normalizes. Was the observed incomplete normalization of volume seen predominantly in those with longer duration of elite performance? Another confounder is the persistence of light recreational activities in the majority (62.5%) of the former athletes. Hickson et al4 showed that continued training at a reduced level could prevent regression of the training-induced morphometric changes in former athletes. Although this study reports no difference in the mean left ventricular cavity size between completely deconditioned athletes and those with persistent exercise, a difference cannot be excluded unless the dimensions are indexed to both the dimensions during peak performance and the relative reduction in peak training represented by detraining activity. This unique database should clarify these important issues.