{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:58:38Z","timestamp":1790297918727,"version":"4.1.0"},"reference-count":27,"publisher":"Open Medical Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endurance exercise induces cardiovascular adaptations known as exercise-induced physiologic remodeling of the athlete\u2019s heart, including sinus bradycardia, chamber enlargement, enhanced vagal tone, and atrial and ventricular remodeling. These changes are generally physiologic, but concern remains about their association with arrhythmias and long-term outcomes. This study aimed to characterize the research landscape, identify influential contributors, and explore emerging themes in this field.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A bibliometric analysis was conducted using the Web of Science Core Collection database. Publications were retrieved from inception through June 11, 2026, yielding 754 results. Annual trends, leading countries, institutions, collaboration networks, and keyword co-occurrence were analyzed using VOSviewer and organized using Microsoft Excel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Publication output grew steadily from the 1990s and plateaued from the mid-2010s onward, without a sharp inflection point. The United States (146) and Italy (126) led national output, followed by England (87) and Australia (77); 36 countries met the network threshold. Institutional output was distributed, led by Liverpool John Moores University, Harvard University, and KU Leuven, while citation strength clustered around Belgian and Italian hubs. Exercise, echocardiography, athlete\u2019s heart, and endurance emerged as dominant keywords. Top-cited works date largely to 1994\u20132002, with citations accumulating over decades.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This field has grown through incremental refinement of a stable question rather than a single catalyst, with a distributed evidence base. Influential work treats athlete\u2019s hearts as benign by default, while emerging themes suggest growing attention toward identifying which athletes deviate toward pathologic remodeling. Cross-hub collaboration is needed to resolve whether an athlete\u2019s heart is one phenomenon or several.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.52965\/001c.171224","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:58:34Z","timestamp":1790294314000},"source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Adaptations in Endurance Athletes: A Bibliometric Analysis of Exercise\u2011Induced Physiologic Remodeling"],"prefix":"10.52965","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1441-6557","authenticated-orcid":false,"given":"Elena","family":"Lorenzi","sequence":"first","affiliation":[{"name":"Abeka Academy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Nichols","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05d23ve83","id-type":"ROR","asserted-by":"publisher"}],"name":"Colgate University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6124-7037","authenticated-orcid":false,"given":"Omar","family":"Viswanath","sequence":"additional","affiliation":[{"name":"Creighton University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7717-3864","authenticated-orcid":true,"given":"Latha","family":"Ganti","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"30777","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"23","key":"ref1","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1136\/heartjnl-2012-303465","article-title":"Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart","volume":"99","author":"V. Utomi","year":"2013","journal-title":"Heart"},{"issue":"3","key":"ref2","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1161\/01.CIR.101.3.336","article-title":"The athlete's heart: a meta-analysis of cardiac structure and function","volume":"101","author":"B. M. Pluim","year":"2000","journal-title":"Circulation"},{"issue":"8","key":"ref3","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1016\/0002-9149(94)90439-1","article-title":"Morphology of the \"athlete's heart\" assessed by echocardiography in 947 elite athletes representing 27 sports","volume":"74","author":"P. Spirito","year":"1994","journal-title":"American Journal of Cardiology"},{"issue":"1","key":"ref4","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1093\/eurheartj\/ehm555","article-title":"Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists","volume":"29","author":"S. Baldesberger","year":"2008","journal-title":"European Heart Journal"},{"issue":"23","key":"ref5","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1093\/eurheartj\/ehv090","article-title":"Exercise and the heart: the good, the bad, and the ugly","volume":"36","author":"S. Sharma","year":"2015","journal-title":"European Heart Journal"},{"issue":"4","key":"ref6","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1152\/japplphysiol.01170.2007","article-title":"Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes","volume":"104","author":"A. L. Baggish","year":"2008","journal-title":"Journal of Applied Physiology"},{"issue":"5","key":"ref7","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1055\/s-2007-1021059","article-title":"Echocardiographic findings in endurance athletes with hypertrophic non-obstructive cardiomyopathy (HNCM) compared to non-athletes with HNCM and to physiological hypertrophy (athlete's heart)","volume":"15","author":"H.-H. Dickhuth","year":"1994","journal-title":"International Journal of Sports Medicine"},{"issue":"9","key":"ref8","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1016\/j.jcmg.2018.09.021","article-title":"Cardiac magnetic resonance normal reference values of biventricular size and function in male athlete's heart","volume":"12","author":"F. D'Ascenzi","year":"2019","journal-title":"JACC: Cardiovascular Imaging"},{"issue":"4","key":"ref9","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/BF03086131","article-title":"Cardiac remodelling: concentric versus eccentric hypertrophy in strength and endurance athletes","volume":"16","author":"C. Mihl","year":"2008","journal-title":"Netherlands Heart Journal"},{"issue":"3","key":"ref10","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s40037-021-00695-4","article-title":"Bibliometrics: methods for studying academic publishing","volume":"11","author":"A. Ninkov","year":"2022","journal-title":"Perspectives on Medical Education"},{"issue":"3","key":"ref11","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1111\/j.1748-1716.1980.tb06600.x","article-title":"Non-autonomic component in bradycardia of endurance-trained men at rest and during exercise","volume":"109","author":"S. F. Lewis","year":"1980","journal-title":"Acta Physiologica Scandinavica"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.62186\/001c.129134","article-title":"Bibliometric analysis methods for the medical literature","volume":"30","author":"L. Ganti","year":"2025","journal-title":"Academic Medicine & Surgery"},{"key":"ref13","article-title":"Bibliometrics and research evaluation: home","author":"National Oceanic and Atmospheric Administration Library","year":"2025","journal-title":"NOAA Library"},{"issue":"24","key":"ref14","doi-asserted-by":"publisher","first-page":"2152","DOI":"10.1161\/CIRCULATIONAHA.114.010775","article-title":"Cardiac remodeling in response to 1 year of intensive endurance training","volume":"130","author":"A. Arbab-Zadeh","year":"2014","journal-title":"Circulation"},{"issue":"7","key":"ref15","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1136\/hrt.2006.101063","article-title":"Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise","volume":"94","author":"A. La Gerche","year":"2008","journal-title":"Heart"},{"issue":"5","key":"ref16","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.3390\/jcm11051316","article-title":"Differences in atrial remodeling in hypertrophic cardiomyopathy compared to hypertensive heart disease and athletes' hearts","volume":"11","author":"H. Servatius","year":"2022","journal-title":"Journal of Clinical Medicine"},{"issue":"4","key":"ref17","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1159\/000175980","article-title":"Electrocardiographic findings according to level of fitness and sport activity","volume":"83","author":"H. Bj\u00f8rnstad","year":"1993","journal-title":"Cardiology"},{"issue":"1","key":"ref18","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1111\/pan.12584","article-title":"Bradycardia in perspective - not all reductions in heart rate need immediate intervention","volume":"25","author":"K. P. Mason","year":"2015","journal-title":"Paediatric Anaesthesia"},{"issue":"1","key":"ref19","doi-asserted-by":"publisher","first-page":"H409","DOI":"10.1152\/ajpheart.00928.2006","article-title":"Diastolic ventricular interactions in endurance-trained athletes during orthostatic stress","volume":"293","author":"B. T. A. Esch","year":"2007","journal-title":"American Journal of Physiology-Heart and Circulatory Physiology"},{"issue":"6","key":"ref20","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S0735-1097(02)01722-9","article-title":"Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes","volume":"39","author":"R. Stein","year":"2002","journal-title":"Journal of the American College of Cardiology"},{"issue":"1","key":"ref21","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1159\/000165849","article-title":"The mechanism of bradycardia evoked by physical training","volume":"51","author":"M. H. Frick","year":"1967","journal-title":"Cardiologia"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"3775","DOI":"10.1038\/ncomms4775","article-title":"Exercise training reduces resting heart rate via downregulation of the funny channel HCN4","volume":"5","author":"A. D'Souza","year":"2014","journal-title":"Nature Communications"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"519382","DOI":"10.3389\/fphys.2020.519382","article-title":"Genetic ablation of G protein-gated inwardly rectifying K+ channels prevents training-induced sinus bradycardia","volume":"11","author":"I. Bidaud","year":"2021","journal-title":"Frontiers in Physiology"},{"issue":"2","key":"ref24","doi-asserted-by":"publisher","first-page":"79","DOI":"10.2165\/00007256-200030020-00002","article-title":"Detraining: loss of training-induced physiological and performance adaptations. Part I: short term insufficient training stimulus","volume":"30","author":"I. Mujika","year":"2000","journal-title":"Sports Medicine"},{"issue":"3","key":"ref25","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/00005768-200103000-00013","article-title":"Cardiorespiratory and metabolic characteristics of detraining in humans","volume":"33","author":"I. Mujika","year":"2001","journal-title":"Medicine & Science in Sports & Exercise"},{"issue":"10","key":"ref26","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1016\/S0735-1097(02)02478-6","article-title":"Athlete's heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging","volume":"40","author":"J. Scharhag","year":"2002","journal-title":"Journal of the American College of Cardiology"},{"issue":"5","key":"ref27","doi-asserted-by":"publisher","first-page":"300","DOI":"10.2165\/00007256-199111050-00003","article-title":"The athletic heart syndrome: a critical review","volume":"11","author":"K. P. George","year":"1991","journal-title":"Sports Medicine"}],"container-title":["Orthopedic Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/171224-cardiac-adaptations-in-endurance-athletes-a-bibliometric-analysis-of-exercise-induced-physiologic-remodeling","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:58:34Z","timestamp":1790294314000},"score":1,"resource":{"primary":{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/171224-cardiac-adaptations-in-endurance-athletes-a-bibliometric-analysis-of-exercise-induced-physiologic-remodeling"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":27,"URL":"https:\/\/doi.org\/10.52965\/001c.171224","relation":{},"ISSN":["2035-8164"],"issn-type":[{"value":"2035-8164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}