Range of right heart measurements in top-level athletes: The training impact
Introduction
Hemodynamic overload due to long-term training typically involves both left and right ventricles, inducing changes in cardiac structure globally described as “athlete's heart” [1], [2].
Cardiac adaptations may vary according to the type of sport. In particular, isotonic exercise associated with endurance sports is responsible for a chronic volume overload, with a predominant increase in left ventricular (LV) mass and end-diastolic diameters (eccentric hypertrophy). On the other hand, isometric exercise, typical of strength disciplines, induces a prevalent increase in LV mass and wall thickness (concentric hypertrophy) [3], [4].
Although standard Doppler echocardiography has been widely used to distinguish the athlete's heart from pathologic LV hypertrophy, only few reports have described right ventricular (RV) and right atrial (RA) adaptations to extensive physical exercise in highly-trained athletes [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. The reasons for this imbalance appear to be related to the complex shape of the RV cavity and its position beneath the sternum, making imaging, measurement and functional assessment much more complex than the LV chamber.
The aim of the present study was therefore to explore the full range of right heart dimensions and the impact of long-term intensive training in a large population of competitive athletes.
Section snippets
Study population
From June 2008 to March 2010, 660 top-level athletes were referred to the Sports Medicine outpatient clinic of Monaldi Hospital, Naples (Italy) for cardiovascular pre-participation screening [16], and afterwards to our echocardiographic laboratory for the purpose of the present study. Among these 650 athletes, 615 had been previously involved in our previous study about the effects of competitive sport training on pulmonary artery systolic pressures [17]. We also studied 230 age- and
Results
The clinical characteristics of the study population are described in Table 1. Mean age was comparable among groups. In accordance with the effects of different training protocols, ATS showed higher resting values of heart rate, body surface area and systolic blood pressure than ATE and controls.
ATS showed increased sum of wall thickness (septum + LV posterior wall), LV relative wall thickness and ESSc, whereas LA volume and LV end-diastolic volume were greater in ATE (Table 2).
All RV and RA
Discussion
A considerable body of echocardiographic studies has described the morphological and functional adaptations of the left ventricle in athletes [1], [2], [3], [4], but only few researches have addressed the impact of long-term intensive training on right heart structure and function.
In this regard, previous reports comparing small cohort of athletes with healthy controls have shown that: i) RV inflow and outflow tract dimensions are significantly greater in athletes; ii) RV tricuspid annulus
Acknowledgments
All the authors are grateful to Prof. Luigi D'Andrea for being constant font of inspiration. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
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