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Myocardial blood flow and its transit time, oxygen utilization, and efficiency of highly endurance-trained human heart

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Abstract

Highly endurance-trained athlete’s heart represents the most extreme form of cardiac adaptation to physical stress, but its circulatory alterations remain obscure. In the present study, myocardial blood flow (MBF), blood mean transit time (MTT), oxygen extraction fraction (OEF) and consumption (MVO2), and efficiency of cardiac work were quantified in highly trained male endurance athletes and control subjects at rest and during supine cycling exercise using [15O]-labeled radiotracers and positron emission tomography. Heart rate and MBF were lower in athletes both at rest and during exercise. OEF increased in response to exercise in both groups, but was higher in athletes (70 ± 21 vs. 63 ± 11 % at rest and 86 ± 13 vs. 73 ± 10 % during exercise). MTT was longer and vascular resistance higher in athletes both at rest and during exercise, but arterial content of 2,3-diphosphoglycerate (oxygen affinity) was unchanged. MVO2 per gram of myocardium trended (p = 0.08) lower in athletes both at rest and during exercise, while myocardial efficiency of work and MVO2 per beat were not different between groups. Arterial levels of free fatty acids were ~twofold higher in athletes likely leading to higher myocardial fatty acid oxidation and hence oxygen cost, which may have blunted the bradycardia-induced decrease in MVO2. Finally, the observed group differences in MBF, OEF, MTT and vascular resistance remained significant also after they were controlled for differences in MVO2. In conclusion, in highly endurance-trained human heart, increased myocardial blood transition time enables higher oxygen extraction levels with a lower myocardial blood flow and higher vascular resistance. These physiological adaptations to exercise training occur independently of the level of oxygen consumption and together with training-induced bradycardia may serve as mechanisms to increase functional reserve of the human heart.

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Acknowledgments

The study was conducted within the Centre of Excellence in Molecular Imaging in Cardiovascular and Metabolic Research—supported by the Academy of Finland, University of Turku, Turku University Hospital and Åbo Akademi University. The authors want to thank the personnel of Turku PET Centre for their excellent assistance. The study was financially supported by the Ministry of Education of the State of Finland (Grants 74/627/2006, 58/627/2007, and 45/627/2008), the Academy of Finland (Grants 108539, 214329 and 251572, and Centre of Excellence funding), the Finnish Cardiovascular Foundation, the Finnish Cultural Foundation and its South-Western Fund, the Finnish Sport Research Foundation, and the Hospital District of Southwest Finland.

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Authors and Affiliations

  1. Turku PET Centre, University of Turku and Turku University Hospital, PO Box 52, 20521, Turku, Finland

    Ilkka Heinonen, Nobuyuki Kudomi, Jukka Kemppainen, Tommi Noponen, Pauliina Luoto, Vesa Oikonen, Hannu T. Sipilä, Juhani Knuuti & Kari K. Kalliokoski

  2. Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Turku, Finland

    Ilkka Heinonen

  3. Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland

    Jukka Kemppainen & Matti Luotolahti

  4. Joint Clinical Biochemistry Laboratory and Department of Clinical Chemistry, University of Turku and Turku University Hospital, Turku, Finland

    Ilkka Mononen

  5. Department of Exercise and Medical Physiology, Verve Research, Oulu, Finland

    Antti Kiviniemi

  6. Division of Pharmacology and Toxicology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland

    Jaakko Kopra

  7. Department of Medical Physics, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Nobuyuki Kudomi

  8. Division of Experimental Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Ilkka Heinonen & Dirk J. Duncker

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  1. Ilkka Heinonen
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Correspondence to Ilkka Heinonen.

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Heinonen, I., Kudomi, N., Kemppainen, J. et al. Myocardial blood flow and its transit time, oxygen utilization, and efficiency of highly endurance-trained human heart. Basic Res Cardiol 109, 413 (2014). https://doi.org/10.1007/s00395-014-0413-1

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