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Abbreviations
MET metabolic exercise training
LV left ventricle
RV right ventricle
LA left atrium
RA right atrium
AoR aortic root
ECG electrocardiography
HCM hypertrophic cardiomyopathy
DCM dilated cardiomyopathy
ARVC arrhytmogenic right ventricular cardiomyopathy
TDI tissue Doppler imaging
RBBB right bundle branch block
TAPSE tricuspid annular plane systolic excursion
PASP pulmonary arterial systolic pressure
CMR cardiac magnetic resonance
PTAC pulmonary transit of agitated contrast
BSA body surface area
LAVI left atrial volume indexed
TNF-α tumor necrosis factor-α
STE speckle tracking echocardiography
BAV bicuspid aortic valve
The physical exercise leads many benefits, especially, in reducing the cardiovascular
risk and in improving quality and expectancy of life. It has been demonstrated that
the regular physical exercise reduces of about 30% the cardiovascular risk in healthy
people [ 1 ]. Moreover, long term regular exercise training determines, especially in
elite athletes, several cardiac structural changes, which represent the “athlete’s heart”,
characterized by bradycardic rhythm at rest and enlarged cardiac chambers [ 2 ].
The current recommended regular physical exercise of 150 min per week ofmoderate physical exercise is far from developing the athlete’s heart. Its develop-
ment occurs in athletes that regularly perform 20 h of intense exercise (15 METs)
per week to participate to competitive races. Cardiac adaptations of the “athlete’s
heart” is affected by many factors as the ethnicity, genetic, age, sex, and type, inten-
sity and duration of exercise. Physical activity determine an increased stroke vol-
ume and enhanced diastolic filling also at high heart rates, reduction of vascular
resistance and of heart rate due to the improvement of vagal tone and reduction of
sympathetic tone. Isotonic or endurance sports (for example walking, running,
swimming and skiing) are characterized by aerobic work and long distance exer-
cise. In acute phase of endurance exercise, there is an increase of cardiac output,
maximum oxygen consumption and peripheral vasodilatation in order to satisfy the
A. D’Andrea et al.