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Martinez, VCorresponding AuthorSanz-De La Garza, MAuthorDomenech-Ximenos, BAuthorGarcia-Alvarez, AAuthorPrat-Gonzalez, SAuthorSitges, MAuthor
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Article

Cardiac and Pulmonary Vascular Remodeling in Endurance Open Water Swimmers Assessed by Cardiac Magnetic Resonance: Impact of Sex and Sport Discipline

Publicated to:Front Cardiovasc Med. 8 719113- - 2021-08-20 8(), DOI: 10.3389/fcvm.2021.719113

Authors: Martinez, Vanessa; Sanz-de La Garza, Maria; Domenech-Ximenos, Blanca; Fernandez, Cesar; Garcia-Alvarez, Ana; Prat-Gonzalez, Susanna; Yanguas, Carles; Sitges, Marta

Affiliations

2.01.01 - Aterosclerosi, malaltia coronària i insuficiència cardíaca. Institut d'Investigacions Biomèdiques August Pi i Sunyer - Author
Univ Barcelona, Hosp Clin, Dept Radiol, Barcelona, Spain - Author
Univ Barcelona, IDIBAPS, Cardiovasc Inst, Hosp Clin, Barcelona, Spain - Author
Xarxa Assistencial Univ Manresa, Dept Cardiol, Fdn Althaia, Manresa, Spain - Author
Xarxa Assistencial Univ Manresa, Fnd Althaia, Dept Radiol, Barcelona, Spain - Author
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Abstract

Background: The cardiac response to endurance exercise has been studied previously, and recent reports have described the extension of this remodeling to the pulmonary vasculature. However, these reports have focused primarily on land-based sports and few data are available on exercise-induced cardio-pulmonary adaptation in swimming. Nor has the impact of sex on this exercise-induced cardio-pulmonary remodeling been studied in depth. The main aim of our study was to evaluate cardiac and pulmonary circulation remodeling in endurance swimmers. Among the secondary objectives, we evaluate the impact of sex and endurance sport discipline on this cardio-pulmonary remodeling promoted by exercise training. Methods:Resting cardiovascular magnetic resonance imaging was performed in 30 healthy well-trained endurance swimmers (83.3% male) and in 19 terrestrial endurance athletes (79% male) to assess biventricular dimensions and function. Pulmonary artery dimensions and flow as well as estimates of pulmonary vascular resistance (PVR) were also evaluated. Results:In relation to the reference parameters for the non-athletic population, male endurance swimmers had larger biventricular and pulmonary artery size (7.4 +/- 1.0 vs. 5.9 +/- 1.1 cm(2), p < 0.001) with lower biventricular ejection fraction (EF) (left ventricular (LV) EF: 58 +/- 4.4 vs. 67 +/- 4.5 %, p < 0.001; right ventricular (RV) EF: 60 +/- 4 vs. 66 +/- 6 %, p < 0.001), LV end-diastolic volume (EDV): 106 +/- 11 vs. 80 +/- 9 ml/m(2), p < 0.001; RV EDV: 101 +/- 14 vs. 83 +/- 12 ml/m(2), p < 0.001). Significantly larger LV volume and lower LV EF were also observed in female swimmers (LV EF: 60 +/- 5.3 vs. 67 +/- 4.6 %, p = 0.003; LV EDV: 90 +/- 17.6 vs. 75 +/- 8.7 ml/m(2), p = 0.002). Compared to terrestrial endurance athletes, swimmers showed increased LV indexed mass (75.0 +/- 12.8 vs. 61.5 +/- 10.0 g/m(2), p < 0.001). The two groups of endurance athletes had similar pulmonary artery remodeling. Conclusions: Cardiac response to endurance swimming training implies an adaptation of both ventricular and pulmonary vasculature, as in the case of terrestrial endurance athletes. Cardio-pulmonary remodeling seems to be less extensive in female than in male swimmers.

Keywords
arterial-hypertensionathletes' heartcardiac remodelingdiastolic functionendurance swimmersestradiolestrogenexercisemasspulmonary circulationright ventricleventricular functionArterial-hypertensionAthletes heartAthletes' heartCardiac remodelingDiastolic functionEndurance swimmersEstradiolEstrogenExerciseMassPulmonary circulationRight ventricleVentricular function

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Front Cardiovasc Med due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Cardiology and Cardiovascular Medicine.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.2, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-06, the following number of citations:

  • WoS: 4
  • Scopus: 2
  • OpenCitations: 5
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-06:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 19.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 19 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 20.704.
  • The number of mentions on the social network X (formerly Twitter): 4 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Martinez, Vanesa Gabriela) and Last Author (Sitges Carreño, Marta).

the author responsible for correspondence tasks has been Martinez, Vanesa Gabriela.