Clinical Investigation
Right Ventricular Function–Influences of Changes in Loading
The Right Ventricle of the Endurance Athlete: The Relationship between Morphology and Deformation

https://doi.org/10.1016/j.echo.2011.11.017Get rights and content

Background

The aims of this study were to establish absolute ranges for right ventricular (RV) structural and functional parameters for endurance athletes and to establish any impact of body size. These data may help differentiate physiologic conditioning from arrhythmogenic RV cardiomyopathy.

Methods

A prospective observational study design was used, and standard two-dimensional echocardiography was performed on 102 endurance athletes, providing RV structural indices. A two-dimensional strain (ε) technique was used to provide indices of RV ε and strain rate. The association of RV chamber size to body surface area (BSA) and functional indices was examined by simple ratio scaling as well as adoption of the general, nonlinear allometric model.

Results

The values for RV inflow, outflow, length, and diastolic area were greater than published “normal ranges” in 57%, 40%, 69%, and 59% of the population, respectively, while 28% of the population had RV outflow tract values greater than the proposed “major criteria” for arrhythmogenic RV cardiomyopathy. Simple ratio scaling for all RV dimensions to BSA did not produce size independence, whereas scaling for BSA allometrically did. Strain and strain rate values were consistent with published normal ranges, and there is no evidence to suggest that scaling is required.

Conclusions

RV chamber dimensions are larger in endurance athletes than those described by “normal ranges” and frequently meet the major criteria for the diagnosis of arrhythmogenic RV cardiomyopathy. Functional assessment of RV ε may aid in this differential diagnosis. RV size is allometrically related to BSA and therefore scaling for population-specific b exponents is encouraged.

Section snippets

Methods

One hundred two endurance athletes (86 men, 16 women) with a broad age range (mean, 36 ± 11 years; range, 21–71 years) volunteered to participate in the study. We recruited elite, internationally competitive athletes via direct contact with athletes, coaches, and race organizers. All athletes were competing at the highest level within their chosen sports, including internationally renowned competitions. Height and body mass were measured using standard equipment; the mean height was 178 ± 8 cm

RV Morphology and Function

Intraobserver variability of RV indices is expressed using the coefficient of variation, with values for ε, SRS′, SRE′, and SRA′ of 7%, 13%, 17%, and 15% respectively. RVOT, RVI, RVL, and RVDarea all provided excellent intraobserver reproducibility, with values of 2%, 1%, 4%, and 4%, respectively.

All RV structural data are presented in Table 1. All 102 athletes had adequate image quality to allow a complete set of RV measurements. The values for RVI ranged from 30 to 55 mm, with 57% of the

Discussion

This study provides absolute values for RV morphologic and functional parameters and is unique in establishing their relationships with body size and RV morphology in a relatively large population of endurance athletes. The structural values confirm some of the findings from smaller studies using magnetic resonance imaging, in that all RV dimensions in athletes are significantly larger than those of the general population and consistently fall into an “abnormal” category when compared with

Acknowledgment

We are grateful to our subjects and all those at Cardiac Risk in the Young who helped facilitate this work.

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