Biventricular mechanical pattern of the athlete’s heart: comprehensive characterization using three-dimensional echocardiography

Abstract

Background While left ventricular (LV) adaptation to regular, intense exercise is thoroughly studied, data are scarce concerning the right ventricular (RV) mechanical changes and their continuum with athletic performance. Aims Accordingly, our aim was to characterize biventricular morphology and function and their relation to sex, age, and sports classes in a large cohort of elite athletes using 3D echocardiography. Methods Elite, competitive athletes (n = 422) and healthy, sedentary volunteers (n = 55) were enrolled. LV and RV end-diastolic volumes (EDVi), and ejection fractions (EF) were measured. In order to characterize biventricular mechanics, LV and RV global longitudinal (GLS) and circumferential strains (GCS) were quantified. All subjects underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Results Athletes had significantly higher LV and RV EDVi compared with controls (athletes vs. controls; LV EDVi: 81 ± 13 vs. 62 ± 11 ml/m2, RV EDVi: 82 ± 14 vs. 63 ± 11 ml/m2; p < 0.001). Concerning biventricular systolic function, athletes had significantly lower resting LV and RV EF (LV EF: 57 ± 4 vs. 61 ± 5%; RV EF: 55 ± 5 vs. 59 ± 5%; p < 0.001). The exercise-induced relative decrease in LV GLS (9.5 ± 10.7%) and LV GCS (10.7 ± 9.8%) was similar, however, the decrement in RV GCS (14.8 ± 17.8%) was disproportionately larger compared with RV GLS (1.7 ± 15.4%, p < 0.01). RV EDVi was found to be the strongest independent predictor of VO2/kg by multivariable linear regression. Conclusions Resting LV mechanics of the athlete's heart is characterized by a balanced decrement in GLS and GCS, however, RV GCS decreases disproportionately compared with RV GLS. Moreover, this mechanical pattern is associated with better exercise capacity.

Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography

“…This technique provides a more precise quantification of ventricular volumes and EF while being highly reproducible and shows good agreement with the gold-standard cardiac magnetic resonance imaging-derived values (14). Moreover, it also offers accurate strain measurement methods to describe the contractile function of the heart, more recently not just in the left ventricle (15,16), but also in its right counterpart (17,18).…”

Reference ventricular dimensions and function parameters by cardiovascular magnetic resonance in highly trained Caucasian athletes

“…Unfortunately, CMR reference values from athletes are scarce [ 30 – 32 , 35 ]. Although the number of patients included in our study was inferior to those reported with echocardiography, it should be considered that the reproducibility of CMR is higher and, consequently, the number of subjects required is significantly lower [ 33 ]. Therefore, our data provided relevant information that may be very valuable for their use clinical practice.…”

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

“…Understanding the structural and functional adaptations in highly trained athletes is essential for differentiating physiological from pathological remodeling in the context of preparticipation evaluation [2,4] and, therefore, constitutes a relevant clinical issue. In any individual, cardiac adaptations to exercise are influenced by several factors including training mode, intensity, duration and volume [1,3,19,[23][24][25][26]. Cardiac remodeling of the right ventricle in athletes was intensively investigated [6,10,[26][27][28][29][30][31][32] and different echocardiographic approaches were proposed to identify pathological changes [1,3,33].…”

“…In any individual, cardiac adaptations to exercise are influenced by several factors including training mode, intensity, duration and volume [1,3,19,[23][24][25][26]. Cardiac remodeling of the right ventricle in athletes was intensively investigated [6,10,[26][27][28][29][30][31][32] and different echocardiographic approaches were proposed to identify pathological changes [1,3,33]. However, so far, accepted reference values for athletes exist mainly for morphological echocardiographic measurements as highlighted in recent meta-analyses [28,32].…”

“…Functional and structural changes of the right and left ventricle, known as the "athlete´s heart", have been described in elite athletes performing mixed and endurance sports disciplines [1][2][3]. These physiological adaptations are considered beneficial to generate high performance levels [4].…”