Right ventricular remodelling induced by exercise training in competitive athletes.

AIMS Conflicting evidence exists concerning right ventricular (RV) morphological and functional remodelling in trained athletes, with a very few longitudinal data prospectively investigating the RV changes. The aim of this study was to assess the morphological and functional RV changes occurring during the competitive season in young athletes engaged in the most popular team sports. METHODS AND RESULTS Twenty-nine top-level athletes (age: 20.9 ± 6.7 years), practicing basketball and volleyball, were evaluated at pre-season, mid-season, and end-season time-points, using tissue Doppler imaging and 2D speckle-tracking echocardiography. RV basal and mid-cavity end-diastolic diameters (EDDs; overall P = 0.011 and P < 0.0001, respectively), and RV diastolic area (overall P < 0.0001) increased during the season. Conversely, RV outflow tract did not vary (overall P = 0.96). During the season, no significant differences were observed in RV diastolic functional indexes and in RV fractional area change (overall P = 0.35). Global RV longitudinal strain did not significantly change (overall P = 0.52), although apical longitudinal strain significantly increased (overall P = 0.017). In association, left ventricular (LV) volume and mass increased during the season (overall P = 0.007). On multivariate analysis, LV mass was the only independent predictor of RVEDD at pre-season (β = 0.69, P < 0.0001) and at end-season (β = 0.82, P < 0.0001). CONCLUSIONS Right ventricular chamber size increases during the competitive season in top-level athletes, with no significant changes in the outflow tract. RV morphological adaptation in top-level athletes practicing team sports is not associated with a reduction in RV function or in myocardial deformation and occurs in close association with changes on the left ventricle, suggesting a physiological remodelling of the right ventricle.

[1]  D. DuBois,et al.  A formula to estimate the approximate surface area if height and weight be known , 1989 .

[2]  D. D. Bois,et al.  CLINICAL CALORIMETRY: TENTH PAPER A FORMULA TO ESTIMATE THE APPROXIMATE SURFACE AREA IF HEIGHT AND WEIGHT BE KNOWN , 1916 .

[3]  W. C. Randall,et al.  Interrelationship of architecture and function of the right ventricle. , 1970, The American journal of physiology.

[4]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[5]  N. Reichek,et al.  Different effects of prolonged exercise on the right and left ventricles. , 1990, Journal of the American College of Cardiology.

[6]  M. Proschan,et al.  The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. , 1991, The New England journal of medicine.

[7]  C. Goldsmith,et al.  Use of the standard error as a reliability index of interest: an applied example using elbow flexor strength data. , 1997, Physical therapy.

[8]  A H Zwinderman,et al.  The athlete's heart. A meta-analysis of cardiac structure and function. , 2000, Circulation.

[9]  Estimation of Mean Right Atrial Pressure Using Tissue Doppler Imaging , 2000 .

[10]  R. Fagard.  Athlete's heart. , 2003, Heart.

[11]  Barry J Maron,et al.  The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. , 2006, Circulation.

[12]  William Stewart,et al.  Recommendations for chamber quantification. , 2006, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

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

[14]  G. Thiene,et al.  Differences and similarities between arrhythmogenic right ventricular cardiomyopathy and athlete’s heart adaptations , 2008, British Journal of Sports Medicine.

[15]  N. Prakken,et al.  Echocardiographic assessment of regional right ventricular function: a head-to-head comparison between 2-dimensional and tissue Doppler-derived strain analysis. , 2008, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[16]  R. Hauer,et al.  Echocardiographic tissue deformation imaging quantifies abnormal regional right ventricular function in arrhythmogenic right ventricular dysplasia/cardiomyopathy. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[17]  Jeffrey C. Hill,et al.  Assessment of the right ventricle by echocardiography: a primer for cardiac sonographers. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[18]  N. Prakken,et al.  Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes. , 2008, European heart journal.

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

[20]  Arturo Evangelista,et al.  Recommendations for the evaluation of left ventricular diastolic function by echocardiography. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[21]  J. Voigt,et al.  Right ventricular function by strain echocardiography , 2010, Current opinion in cardiology.

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

[23]  Wojciech Zareba,et al.  Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: Proposed Modification of the Task Force Criteria , 2010, Circulation.

[24]  J. Voigt,et al.  Regional right ventricular deformation in patients with open and closed atrial septal defect. , 2011, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[25]  J. Lacalzada,et al.  Evaluation of Left Ventricular Diastolic Function by Echocardiography , 2011 .

[26]  童鸿.  Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia： Proposed Modification of the Task Force Criteria , 2011 .

[27]  Victor Mor-Avi,et al.  Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. , 2011, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[28]  S. Caselli,et al.  Three-dimensional echocardiographic characterization of left ventricular remodeling in Olympic athletes. , 2011, The American journal of cardiology.

[29]  K. George,et al.  171 The right ventricle of the endurance athlete: the relationship between morphology and deformation , 2011, Heart.

[30]  H. Heidbüchel,et al.  The right heart in athletes. Evidence for exercise-induced arrhythmogenic right ventricular cardiomyopathy. , 2012, Herzschrittmachertherapie & Elektrophysiologie.

[31]  Jan Bogaert,et al.  Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. , 2012, European heart journal.

[32]  M. Bonifazi,et al.  Characterization of right atrial function and dimension in top-level athletes: a speckle tracking study , 2012, The International Journal of Cardiovascular Imaging.

[33]  F. D’Ascenzi,et al.  Left Atrial Remodelling in Competitive Adolescent Soccer Players , 2012, International Journal of Sports Medicine.

[34]  Pieter A Doevendans,et al.  Early detection of regional functional abnormalities in asymptomatic ARVD/C gene carriers. , 2012, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[35]  G. Di Salvo,et al.  Right ventricular morphology and function in top-level athletes: a three-dimensional echocardiographic study. , 2012, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[36]  Ahmed M. Shehata,et al.  Value of Conventional and Tissue Doppler Echocardiography in the Noninvasive Measurement of Right Atrial Pressure , 2012, Echocardiography.

[37]  J. D’hooge,et al.  Exercise strain rate imaging demonstrates normal right ventricular contractile reserve and clarifies ambiguous resting measures in endurance athletes. , 2012, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[38]  G. Di Salvo,et al.  Range of right heart measurements in top-level athletes: the training impact. , 2013, International journal of cardiology.

[39]  E. Kouidi,et al.  Right atrial and ventricular adaptations to training in male Caucasian athletes: an echocardiographic study. , 2013, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[40]  D. Oxborough,et al.  Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin , 2013, Circulation.

[41]  Erwan Donal,et al.  Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. , 2014, European heart journal cardiovascular Imaging.

[42]  S. Solomon,et al.  GUIDELINES AND STANDARDS , 2010 .

[43]  D. Corrado,et al.  Morphological and Functional Adaptation of Left and Right Atria Induced by Training in Highly Trained Female Athletes , 2014, Circulation. Cardiovascular imaging.