Disproportionate exercise load and remodeling of the athlete's right ventricle.

PURPOSE There is evolving evidence that intense exercise may place a disproportionate load on the right ventricle (RV) when compared with the left ventricle (LV) of the heart. Using a novel method of estimating end-systolic wall stress (ES-σ), we compared the RV and LV during exercise and assessed whether this influenced chronic ventricular remodeling in athletes. METHODS For this study, 39 endurance athletes (EA) and 14 nonathletes (NA) underwent resting cardiac magnetic resonance (CMR), maximal oxygen uptake (VO2), and exercise echocardiography studies. LV and RV end-systolic wall stress (ES-σ) were calculated using the Laplace relation (ES-σ = Pr/(2h)). Ventricular size and wall thickness were determined by CMR; invasive and Doppler echo estimates were used to measure systemic and pulmonary ventricular pressures, respectively; and stroke volume was quantified by Doppler echocardiography and used to calculate changes in ventricular geometry during exercise. RESULTS In EA, compared with NA, resting CMR measures showed greater RV than LV remodeling. The ratios RV ESV/LV ESV (1.40 ± 0.23 vs 1.26 ± 0.12, P = 0.007) and RV mass/LV mass (0.29 ± 0.04 vs 0.25 ± 0.03, P = 0.012) were greater in EA than in NA. RVES-σ was lower at rest than LVES-σ (143 ± 44 vs 252 ± 49 kdyn · cm, P < 0.001) but increased more with strenuous exercise (125% vs 14%, P < 0.001), resulting in similar peak exercise ES-σ (321 ± 106 vs 286 ± 77 kdyn · cm, P = 0.058). Peak exercise RVES-σ was greater in EA than in NA (340 ± 107 vs 266 ± 82 kdyn · cm, P = 0.028), whereas RVES-σ at matched absolute workloads did not differ (P = 0.79). CONCLUSIONS Exercise induces a relative increase in RVES-σ which exceeds LVES-σ. In athletes, greater RV enlargement and greater wall thickening may be a product of this disproportionate load excess.

[1]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[2]  J. Parish,et al.  The noninvasive evaluation of exercise-induced changes in pulmonary artery pressure and pulmonary vascular resistance. , 2007, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[3]  J. Marshall,et al.  Myocardial Injury and Ventricular Dysfunction Related to Training Levels Among Nonelite Participants in the Boston Marathon , 2006, Circulation.

[4]  R. Janz,et al.  Estimation of local myocardial stress. , 1982, The American journal of physiology.

[5]  A Berghold,et al.  Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review , 2009, European Respiratory Journal.

[6]  Horst Olschewski,et al.  Assessment of pulmonary arterial pressure during exercise in collagen vascular disease: echocardiography vs right-sided heart catheterization. , 2010, Chest.

[7]  D. Jassal,et al.  Relation of biomarkers and cardiac magnetic resonance imaging after marathon running. , 2009, The American journal of cardiology.

[8]  J. Ganame,et al.  Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment. , 2007, European heart journal.

[9]  Wilfried Kindermann,et al.  Athlete's heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. , 2002, Journal of the American College of Cardiology.

[10]  H. Heidbuchel,et al.  High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias. Role of an electrophysiologic study in risk stratification. , 2003, European heart journal.

[11]  K. Chinnaiyan,et al.  Acute cardiac effects of marathon running. , 2010, Journal of applied physiology.

[12]  P. Anversa,et al.  Morphometry of Exercise‐Induced Right Ventricular Hypertrophy in the Rat , 1983, Circulation research.

[13]  James C Moon,et al.  Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance. , 2004, American heart journal.

[14]  F. Yin,et al.  Ventricular wall stress. , 1981, Circulation research.

[15]  J. Cnota,et al.  Cardiovascular physiology during supine cycle ergometry and dobutamine stress. , 2003, Medicine and science in sports and exercise.

[16]  J M Norton,et al.  Toward consistent definitions for preload and afterload. , 2001, Advances in physiology education.

[17]  P. Anversa,et al.  Morphometry of right ventricular hypertrophy induced by strenuous exercise in rat. , 1982, The American journal of physiology.

[18]  P. Scifo,et al.  Effect of the sporting discipline on the right and left ventricular morphology and function of elite male track runners: a magnetic resonance imaging and phosphorus 31 spectroscopy study. , 2007, American heart journal.

[19]  L. Hittinger,et al.  Contributions of heart rate and contractility to myocardial oxygen balance during exercise. , 2003, American journal of physiology. Heart and circulatory physiology.

[20]  F. Prinzen,et al.  Relation between left ventricular cavity pressure and volume and systolic fiber stress and strain in the wall. , 1991, Biophysical journal.

[21]  D. Prior,et al.  Athlete's heart: the potential for multimodality imaging to address the critical remaining questions. , 2009, JACC. Cardiovascular imaging.

[22]  R M Gardner,et al.  Direct blood pressure measurement--dynamic response requirements. , 1981, Anesthesiology.

[23]  Takahiro Iwami,et al.  The usefulness of a 10% air-10% blood-80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure. , 2002, Journal of the American College of Cardiology.

[24]  H. Heidbuchel,et al.  Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin , 2010, Heart.

[25]  T. Rowland.  Echocardiography and Circulatory Response to Progressive Endurance Exercise , 2008, Sports medicine.

[26]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[27]  N. Westerhof,et al.  Comparison of models used to calculate left ventricular wall force , 1980, Medical and Biological Engineering and Computing.

[28]  K. Peterson,et al.  The development of the entire end-systolic pressure-volume and ejection fraction-afterload relations: a new concept of systolic myocardial stiffness. , 1987, Circulation.

[29]  N. Dean,et al.  Noninvasive Evaluation of Pulmonary Artery Pressure During Exercise by Saline-Enhanced Doppler Echocardiography in Chronic Pulmonary Disease , 1989, Circulation.

[30]  D. Welsh,et al.  The relationship between the components of pulmonary artery pressure remains constant under all conditions in both health and disease. , 2008, Chest.

[31]  B. Groves,et al.  Importance of right ventricular end-systolic regional wall stress in idiopathic pulmonary arterial hypertension: a new method for estimation of right ventricular wall stress. , 2006, European journal of medical research.

[32]  Jens-Uwe Voigt,et al.  Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function during exercise. , 2010, Journal of applied physiology.

[33]  K. Connelly,et al.  Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise , 2007, Heart.

[34]  M. K. Heng,et al.  Changes in left ventricular wall stress during isometric and isotonic exercise in healthy men. , 1988, The American journal of cardiology.

[35]  D. Bluemke,et al.  Physical activity and right ventricular structure and function. The MESA-Right Ventricle Study. , 2011, American journal of respiratory and critical care medicine.

[36]  G. Breithardt,et al.  Age- and Training-Dependent Development of Arrhythmogenic Right Ventricular Cardiomyopathy in Heterozygous Plakoglobin-Deficient Mice , 2006, Circulation.

[37]  W. Paulus,et al.  Opposite Effects of Training in Rats With Stable and Progressive Pulmonary Hypertension , 2009, Circulation.

[38]  S. Abbara.  Atrial and ventricular functional and structural adaptations of the heart in elite triathletes assessed with cardiac MR imaging , 2011 .

[39]  J. Zwanenburg,et al.  Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. , 2008, Journal of the American College of Cardiology.

[40]  M. Rubenfire,et al.  Range of tricuspid regurgitation velocity at rest and during exercise in normal adult men: implications for the diagnosis of pulmonary hypertension. , 1999, Journal of the American College of Cardiology.

[41]  N. Chesler,et al.  Exercise stress echocardiography for the study of the pulmonary circulation , 2009, European Respiratory Journal.