{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:32:00Z","timestamp":1785198720345,"version":"3.55.0"},"reference-count":59,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Higher Education of Poland","award":["NdS-II\/SP\/0431\/2024\/01"],"award-info":[{"award-number":["NdS-II\/SP\/0431\/2024\/01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Exposure to hypoxia is widely used to enhance training adaptations, but its acute effects on cardiac function remain unclear. Exercise-induced cardiac fatigue (EICF), defined as transient impairments in left ventricular (LV) systolic and diastolic function, has been reported after endurance exercise. Whether moderate hypoxia influences EICF, particularly in athletes, is unknown. Methods: Twenty-four healthy men participated: 12 endurance-trained cyclists (T) and 12 untrained individuals (UT). Each completed two exhaustive cycling tests under normoxia (FiO2 = 20.9%) and moderate normobaric hypoxia (FiO2 = 14.4%; ~3000 m). Echocardiography was performed at rest and immediately post-exercise to assess LV systolic and diastolic function. Results: Exhaustive exercise reduced LV diastolic function in both groups, with no significant condition-related differences. Under normoxia, early peak filling velocity (Mitral E) decreased by 21.2% in UT and 23.2% in T, and under hypoxia, by 16.2% in UT and 14.9% in T. Global longitudinal strain (LV GLS) became less negative after exercise under normoxia (UT: +25.2%, T: +30.6%) and hypoxia (UT: +24.8%, T: +20.3%). Athletes exhibited slightly less post-exercise systolic impairment under hypoxia than normoxia, reflected by the maintenance of a more negative LV GLS (\u2206GLS: 6.87 \u00b1 2.65% in normoxia vs. 4.55 \u00b1 1.86% in hypoxia, p &lt; 0.05). Conclusions: Moderate normobaric hypoxia (~3000 m) did not exacerbate EICF in either group. Athletes showed slightly less post-exercise systolic impairment under hypoxia. Moderate hypoxia may modify the cardiac response to exhaustive exercise, but studies with larger samples and direct preload assessment are needed.<\/jats:p>","DOI":"10.3390\/jcm14238391","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T13:56:34Z","timestamp":1764165394000},"page":"8391","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Moderate Normobaric Hypoxia Does Not Exacerbate Left Ventricular Dysfunction After Exhaustive Exercise in Athletes and Untrained Individuals"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8305-8130","authenticated-orcid":false,"given":"Robert","family":"Gajda","sequence":"first","affiliation":[{"name":"Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200 Czestochowa, Poland"},{"name":"Center for Sports Cardiology, Gajda-Med Medical Center in Pultusk, 06-100 Pultusk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3516-9124","authenticated-orcid":false,"given":"Kamila","family":"P\u0142oszczyca","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation, J\u00f3zef Pi\u0142sudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5389-6822","authenticated-orcid":false,"given":"Ewa","family":"Kowalik","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1813-8871","authenticated-orcid":false,"given":"Adam","family":"Niemaszyk","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation, J\u00f3zef Pi\u0142sudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7419-8943","authenticated-orcid":false,"given":"Micha\u0142","family":"Starczewski","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation, J\u00f3zef Pi\u0142sudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Grzebisz-Zato\u0144ska","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation, J\u00f3zef Pi\u0142sudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4110-8571","authenticated-orcid":false,"given":"Katarzyna","family":"Kaczmarczyk","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation, J\u00f3zef Pi\u0142sudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f3zef","family":"Langfort","sequence":"additional","affiliation":[{"name":"Department of Sports Theory, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi\u0142osz","family":"Czuba","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation, J\u00f3zef Pi\u0142sudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2165\/11317920-000000000-00000","article-title":"Combining hypoxic methods for peak performance","volume":"40","author":"Millet","year":"2010","journal-title":"Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"P\u0142oszczyca, K., Langfort, J., and Czuba, M. (2018). The effects of altitude training on erythropoietic response and hematological variables in adult athletes: A narrative review. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.00375"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1089\/ham.2013.1022","article-title":"Timing of arrival and pre-acclimatization strategies for the endurance athlete competing at moderate to high altitudes","volume":"14","author":"Chapman","year":"2013","journal-title":"High Alt. Med. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Millet, G.P., Debevec, T., Brocherie, F., Malatesta, D., and Girard, O. (2016). Therapeutic use of exercising in hypoxia: Promises and limitations. Front. Physiol., 7.","DOI":"10.3389\/fphys.2016.00224"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"173","DOI":"10.2478\/bhk-2025-0017","article-title":"The use of intermittent hypoxic training in rehabilitation, prevention, and treatment of non-communicable diseases (NCDs): A narrative review","volume":"17","author":"Niemaszyk","year":"2025","journal-title":"Biomed. Hum. Kinet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.7150\/ijms.86622","article-title":"Intermittent hypoxia conditioning: A potential multi-organ protective therapeutic strategy","volume":"20","author":"Zhang","year":"2023","journal-title":"Int. J. Med. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1113\/jphysiol.2006.113936","article-title":"Arterial oxygenation influences central motor output and exercise performance via effects on peripheral locomotor muscle fatigue in humans","volume":"575","author":"Amann","year":"2006","journal-title":"J. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s004210050281","article-title":"Effects of oxygen fraction in inspired air on force production and electromyogram activity during ergometer rowing","volume":"76","author":"Peltonen","year":"1997","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1152\/jappl.1980.49.5.863","article-title":"Oxygen uptake, acid-base status, and performance with varied inspired oxygen fractions","volume":"49","author":"Adams","year":"1980","journal-title":"J. Appl. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1152\/jappl.1999.86.4.1367","article-title":"Human muscle performance and PCr hydrolysis with varied inspired oxygen fraction: A 31P-MRS study","volume":"86","author":"Hogan","year":"1999","journal-title":"J. Appl. Physiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.pcad.2010.03.004","article-title":"Physiological adaptation of the cardiovascular system to high altitude","volume":"52","author":"Naeije","year":"2010","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/sms.12619","article-title":"Regulation of cardiac output in hypoxia","volume":"25","author":"Siebenmann","year":"2015","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1038\/s41569-023-00924-9","article-title":"Cardiovascular physiology and pathophysiology at high altitude","volume":"21","author":"Richalet","year":"2024","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_14","first-page":"904","article-title":"Oxygen uptake response during maximal cycling in hyperoxia, normoxia and hypoxia","volume":"72","author":"Peltonen","year":"2001","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1113\/expphysiol.2012.069112","article-title":"Pulmonary hypertension and the right ventricle in hypoxia","volume":"98","author":"Naeije","year":"2013","journal-title":"Exp. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"H1391","DOI":"10.1152\/ajpheart.00332.2005","article-title":"Right and left ventricular adaptation to hypoxia: A tissue Doppler imaging study","volume":"289","author":"Huez","year":"2005","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1089\/ham.2012.1009","article-title":"The effects of acute hypobaric hypoxia on arterial stiffness and endothelial function and its relationship to changes in pulmonary artery pressure and left ventricular diastolic function","volume":"13","author":"Boos","year":"2012","journal-title":"High Alt. Med. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1253\/jcj.56.998","article-title":"The effect of acute hypoxia on left ventricular function with special reference to diastolic function: An analysis using ultrasonic method","volume":"56","author":"Maruyama","year":"1992","journal-title":"Jpn. Circ. J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"B\u00f6lter, C., Gabriel, P., Appelt, P., Salameh, A., Schierle, K., and Rassler, B. (2019). Effects of adrenergic agonists and antagonists on cardiopulmonary function during normobaric hypoxia in rat. Front. Physiol., 10.","DOI":"10.3389\/fphys.2019.00860"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1152\/japplphysiol.00898.2009","article-title":"Impaired left and right ventricular function following prolonged exercise in young athletes: Influence of exercise intensity and responses to dobutamine stress","volume":"108","author":"Banks","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_21","first-page":"688","article-title":"Impact of high-intensity endurance exercise on regional left and right ventricular myocardial mechanics","volume":"18","author":"Stewart","year":"2017","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1002\/j.2040-4603.2012.tb00405.x","article-title":"Pulmonary circulation at exercise","volume":"2","author":"Naeije","year":"2012","journal-title":"Compr. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2165\/00007256-200333050-00003","article-title":"Does the human heart fatigue subsequent to prolonged exercise?","volume":"33","author":"Dawson","year":"2003","journal-title":"Sports Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1249\/01.mss.0000210203.10200.12","article-title":"Left ventricular function immediately following prolonged exercise: A meta-analysis","volume":"38","author":"Middleton","year":"2006","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Czuba, M., Bril, G., P\u0142oszczyca, K., Piotrowicz, Z., Chalimoniuk, M., Roczniok, R., Zembro\u0144-\u0141acny, A., Gerasimuk, D., and Langfort, J. (2019). Intermittent hypoxic training at lactate threshold intensity improves aiming performance in well-trained biathletes with little change of cardiovascular variables. Biomed. Res. Int., 2019.","DOI":"10.1155\/2019\/1287506"},{"key":"ref_26","first-page":"175","article-title":"The effects of intermittent hypoxic training on aerobic capacity and endurance performance in cyclists","volume":"10","author":"Czuba","year":"2011","journal-title":"J. Sports Sci. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Czuba, M., Wilk, R., Karpi\u0144ski, J., Chalimoniuk, M., Zajac, A., and Langfort, J. (2017). Intermittent hypoxic training improves anaerobic performance in competitive swimmers when implemented into a direct competition mesocycle. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0180380"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1089\/ham.2008.1092","article-title":"Endurance training at altitude","volume":"10","author":"Saunders","year":"2009","journal-title":"High Alt. Med. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.pcad.2010.02.013","article-title":"Is hypoxia training good for muscles and exercise performance?","volume":"52","author":"Vogt","year":"2010","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e20188","DOI":"10.1016\/j.heliyon.2023.e20188","article-title":"Effect of altitude training on the aerobic capacity of athletes: A systematic review and meta-analysis","volume":"9","author":"Chen","year":"2023","journal-title":"Heliyon"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Goliniewski, J., Czuba, M., P\u0142oszczyca, K., Chalimoniuk, M., Gajda, R., Niemaszyk, A., Kaczmarczyk, K., and Langfort, J. (2024). The impact of normobaric hypoxia and intermittent hypoxic training on cardiac biomarkers in endurance athletes: A pilot study. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25094584"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.echo.2020.12.003","article-title":"Exercise-induced cardiac fatigue after a 45-minute bout of high-intensity running exercise is not altered under hypoxia","volume":"34","author":"Kleinnibbelink","year":"2021","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/BF00361545","article-title":"Experimental acute hypoxia in healthy subjects: Evaluation of systolic and diastolic function of the left ventricle at rest and during exercise using echocardiography","volume":"70","author":"Kullmer","year":"1995","journal-title":"Eur. J. Appl. Physiol. Occup. Physiol."},{"key":"ref_34","first-page":"561","article-title":"Impact of acute normobaric hypoxia on regional and global myocardial function: A speckle tracking echocardiography study","volume":"29","author":"Goebel","year":"2013","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1055\/s-2007-1021309","article-title":"A new approach for the determination of ventilatory and lactate thresholds","volume":"13","author":"Cheng","year":"1992","journal-title":"Int. J. Sports Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1093\/ehjci\/jew082","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"17","author":"Nagueh","year":"2016","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/S0735-1097(99)00633-6","article-title":"Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema","volume":"35","author":"Mereles","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"H875","DOI":"10.1152\/ajpheart.00917.2014","article-title":"Altered ventricular mechanics after 60 min of high-intensity endurance exercise: Insights from exercise speckle-tracking echocardiography","volume":"308","author":"Stewart","year":"2015","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1152\/japplphysiol.00570.2022","article-title":"Investigating the roles of exercise intensity and biological sex on postexercise alterations in cardiac function","volume":"134","author":"Coates","year":"2023","journal-title":"J. Appl. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1161\/01.RES.58.2.281","article-title":"Regulation of stroke volume during submaximal and maximal upright exercise in normal man","volume":"58","author":"Higginbotham","year":"1986","journal-title":"Circ. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/0735-1097(89)90187-3","article-title":"Effect of long-term high intensity aerobic training on left ventricular volume during maximal upright exercise","volume":"14","author":"Ginzton","year":"1989","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1055\/s-2007-1021269","article-title":"Depressed systolic and diastolic cardiac function after prolonged aerobic exercise in healthy subjects","volume":"13","author":"Ketelhut","year":"1992","journal-title":"Int. J. Sports Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1097\/00005768-200006000-00005","article-title":"Cardiac fatigue following prolonged endurance exercise of differing distances","volume":"32","author":"Whyte","year":"2000","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s00259-004-1652-4","article-title":"Left ventricular end-diastolic volume is decreased at maximal exercise in athletes with marked repolarisation abnormalities: A continuous radionuclide monitoring study","volume":"32","author":"Flotats","year":"2005","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_46","unstructured":"Guyton, A.C., and Hall, J.E. (2000). Heart muscle; the heart as a pump. A Textbook of Physiology, Saunders."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s00421-005-1318-3","article-title":"Cardiac drift during prolonged exercise with echocardiographic evidence of reduced diastolic function of the heart","volume":"94","author":"Dawson","year":"2005","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.echo.2007.04.032","article-title":"Effect of preload augmentation on pulsed wave and tissue Doppler echocardiographic indices of diastolic function after a marathon","volume":"20","author":"Hart","year":"2007","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ijcard.2006.11.042","article-title":"Altered left ventricular diastolic filling following a marathon is a reproducible phenomenon","volume":"122","author":"Middleton","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s00421-007-0427-6","article-title":"The effect of acute hypoxia on left ventricular function during exercise","volume":"100","author":"Yan","year":"2007","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"R598","DOI":"10.1152\/ajpregu.00269.2006","article-title":"Effect of acute severe hypoxia on peripheral fatigue and endurance capacity in healthy humans","volume":"292","author":"Romer","year":"2007","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1152\/japplphysiol.01008.2007","article-title":"Convective oxygen transport and fatigue","volume":"104","author":"Amann","year":"2008","journal-title":"J. Appl. Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1536\/ihj.25.487","article-title":"Simultaneous changes of left ventricular and left atrial size and function in normal subjects during exercise","volume":"25","author":"Furukawa","year":"1984","journal-title":"Jpn. Heart J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s12968-017-0416-9","article-title":"Atrial volume and function during exercise in health and disease","volume":"19","author":"Schnell","year":"2017","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1111\/sms.12610","article-title":"Differential atrial performance at rest and exercise in athletes: Potential trigger for developing atrial dysfunction?","volume":"26","author":"Gabrielli","year":"2016","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"ldae021","DOI":"10.1093\/bmb\/ldae021","article-title":"The athlete\u2019s heart\u2014From acute stimulus to chronic adaptation","volume":"153","author":"Maxwell","year":"2025","journal-title":"Br. Med. Bull."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S173","DOI":"10.1055\/s-2007-972920","article-title":"Assessment of left ventricular dimensions and functions in athletes and sedentary subjects at rest and during exercise using echocardiography, Doppler sonography and radionuclide ventriculography","volume":"17","author":"Huonker","year":"1996","journal-title":"Int. J. Sports Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"S145","DOI":"10.1055\/s-2007-972916","article-title":"Sports-specific adaptation of left ventricular muscle mass in athlete\u2019s heart. I. An echocardiographic study with combined isometric and dynamic exercise trained athletes (male and female rowers)","volume":"17","author":"Urhausen","year":"1996","journal-title":"Int. J. Sports Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1111\/cpf.12341","article-title":"Limits of ventricular function: From athlete\u2019s heart to a failing heart","volume":"37","author":"Lippi","year":"2017","journal-title":"Clin. Physiol. Funct. Imaging"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8391\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T14:07:47Z","timestamp":1764166067000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":59,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238391"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238391","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,26]]}}}