Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes

Teske, Arco J.; Prakken, Niek H J; Boeck, Bart W De; Velthuis, Birgitta K.; Martens, Edwin P.; Doevendans, Pieter A.; Cramer, Maarten J.

doi:10.1093/eurheartj/ehp040

Cited by 135 publications

(154 citation statements)

References 31 publications

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“…5,[9][10][11]24,26,27 Nonspecific ECG markers of pathology were also entered into analyses (left-and right-axis deviation, LV hypertrophy, RV hypertrophy, any TWI, and anterior TWI). Reproducibility of RV measurements was assessed with intraclass correlation coefficient analysis and reported as intraclass correlation coefficient (95% confidence interval [CI]).…”

Section: Discussionmentioning

confidence: 99%

“…24,25 Independent variables were selected on the basis of associations with LV or RV size in previous studies of athletes (age, sex, BSA, endurance sports, HD-HS sports, ethnicity, training intensity, LV end-diastolic diameter, LV mass index, pulmonary artery systolic pressure, and partial or complete right bundle-branch block). 5,[9][10][11]24,26,27 Nonspecific ECG markers of pathology were also entered into analyses (left-and right-axis deviation, LV hypertrophy, RV hypertrophy, any TWI, and anterior TWI). Reproducibility of RV measurements was assessed with intraclass correlation coefficient analysis and reported as intraclass correlation coefficient (95% confidence interval [CI]).…”

Section: Discussionmentioning

confidence: 99%

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Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

et al. 2013

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Background-Regular, intensive exercise results in physiological biventricular cardiac adaptation. Ethnicity is an established determinant of left ventricular remodeling; black athletes (BAs) exhibit more profound LV hypertrophy than white athletes (WAs). Right ventricular (RV) remodeling has not been characterized in BAs, although the issue is pertinent because BAs commonly exhibit ECG anomalies that resemble arrhythmogenic RV cardiomyopathy. Methods and Results-Between 2006 and 2012, 300 consecutive BAs (n=243 males) from 25 sporting disciplines were evaluated by use of ECG and echocardiography. Results were compared with 375 WAs and 153 sedentary control subjects (n=69 blacks). There were no ethnic differences between RV parameters in control subjects. Both BAs and WAs exhibited greater RV dimensions than control subjects. RV dimensions were marginally smaller in BAs than in WAs (proximal outflow tract, 30.9±5.5 versus 32.8±5.3 mm, P<0.001; longitudinal dimension, 86.6±9.5 versus 89.8±9.6 mm, P<0.001), although only 2.3% of variation was attributable to ethnicity. RV enlargement compatible with diagnostic criteria for arrhythmogenic RV cardiomyopathy was frequently observed (proximal outflow tract ≥32 mm; 45.0% of BAs, 58.5% of WAs). Anterior T-wave inversion was present in 14.3% of BAs versus 3.7% of WAs (P<0.001). Marked RV enlargement with concomitant anterior T-wave inversion was observed in 3.0% of BAs versus 0.3% of WAs (P=0.005). Further investigation did not diagnose arrhythmogenic RV cardiomyopathy in any athlete. Conclusions-Physiological RV enlargement is commonly observed in both black and white athletes. The impact of ethnicity is minimal, which obviates the need for race-specific RV reference values. However, in the context of frequent ECG repolarization anomalies in BAs, the potential for erroneous diagnosis of arrhythmogenic RV cardiomyopathy is considerably greater in this ethnic group. (Circulation. 2013;127:1783-1792.)Key Words: cardiomyopathy ◼ echocardiography ◼ electrocardiographic screening ◼ ethnicity ◼ exercise © 2013 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.112.000270Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received December 6, 2012; accepted March 4, 2013. From St. George's University of London, London, United Kingdom (A.Z., S. Ghani, R.S., N.S., S. Gati, M.P., S.S.); University Hospital Lewisham, London, United Kingdom (A.Z., S. Ghani, N.S., S. Gati, S.S.); Liverpool John Moores University, Liverpool, United Kingdom (D.O.); and Imperial College Healthcare NHS Trust, London, United Kingdom (V.F.P. [WAs]). 10,11 The influence of ethnicity on athletic RV remodeling has never been characterized, even though healthy BAs frequently reveal ECG repolarization anomalies that resemble those observed in ARVC.12 Furthermore, BAs comprise a growing number of elite sports participants worldwide, and for reasons that remain incompletely under...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

et al. 2013

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“…Increased atrial chamber size and increased basal right ventricular diameter are a result of physiological adaptation and response to the nature of cardiac load in athletes engaged in disciplines where one of the components of the exercise is maximum dynamic load. In these athletes, exercise is associated with a large increase in cardiac output, resulting in volume overload and subsequent increase in cardiac chamber size and volume [23]. We did not find differences in left ventricular myocardial thickness and mass, which might be expected when comparing athletes with and without the ER pattern.…”

Section: Nsmentioning

confidence: 37%

Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers

et al. 2016

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A b s t r a c t Background:The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. Aim:To determine the prevalence and determinants of ER in a group of young high endurance athletes. Methods:We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO 2 max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). Results:We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO 2 max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/µL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm 2 /m 2 , p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm 2 /m 2 , p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m 2 , p = 0.04). We found no significant differences in any other cardiac size and function parameters.Conclusions: ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athlete's heart. The significance of these alterations should be evaluated in prospective follow-up studies.

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“…30, 143 However, there are reports of increased e' in the basal RV of speedskaters, 119 long-distance swimmers 26, 28 and rowers 5 compared to controls, or even lower in water polo players than in controls. 120 This inconsistency in previous results could probably in part be explained by the diversity in sports performed by included endurance athletes.…”

Section: 136mentioning

confidence: 99%

“…5, 143 In normal subjects, the RV has been found to be more dependent on longitudinal shortening than the LV.…”

Section: 26 72 111mentioning

confidence: 99%

Cardiac function and long-term volume load : Physiological investigations in endurance athletes and in patients operated on for aortic regurgitation

Hedman¹

2016

Linköping University Medical Dissertations

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Background and aims. The heart is a remarkably adaptable organ, continuously changing its output to match metabolic demands and haemodynamic load. But also in long-term settings, such as in chronic or repeated volume load, there are changes in cardiac dimensions and mass termed cardiac hypertrophy. Depending on the stimulus imposing the volume load this hypertrophy differs in extent and phenotype. We aimed to study cardiac function in two settings with long-term volume load, including patients previously operated for aortic regurgitation and healthy females performing endurance training. Methods. In paper I, 21 patients (age 52±12 years, all male) operated on with aortic valve replacement for aortic regurgitation (AR) underwent a cardiopulmonary exercise test (CPET) and an echocardiographic evaluation in average 49±15 months following surgery. The peak oxygen uptake (peakVO2) was compared to results from a pre-operative and a six months follow-up, and relations to echocardiographic measures were determined. In papers II–IV, 48 endurance trained female athletes (ATH, age 21±2 years) were compared to 46 untrained females (CON, age 21±2 years) regarding echocardiographic measures of cardiac dimensions, global and regional cardiac function and maximal aerobic capacity (VO2max) determined with CPET. Relations between VO2max and cardiac variables were explored. Results. In paper I, peakVO2 had decreased from 26±6 to 23±5 mL/kg/min in patients from the first to second, late follow-up. This decrease was larger than expected by their increased age alone, and a majority of patients had a cardiorespiratory fitness below average according to reference values from healthy subjects of the same age, sex and weight. In papers II–IV, we found that ATH (VO2max 52±5 mL/kg/min) had larger atrial, ventricular and inferior vena cava dimensions compared to CON (VO2max 39±5 mL/kg/min). ATH had increased measures of right ventricular (RV) systolic function (RV atrioventricular plane displacement indexed by cardiac length 2.5±0.3 vs. 2.3±0.3, p=0.001) and left ventricular (LV) diastolic function (mitral E-wave velocity 0.92±0.17 vs. 0.86±0.11 m/s, p=0.029). In addition, systolic synchrony was similar between groups while there were heterogeneous differences in diastolic and systolic function across different myocardial segments. VO2max was most strongly related to LV end-diastolic volume (r=0.709, p<0.001). Conclusions. Decreasing peakVO2 following surgery for AR, despite a normalisation in cardiac dimension could either be a result of a remaining, slight myocardial dysfunction or post-operative negative influence on cardiac performance by filling disturbances or the prosthetic valve itself, or, a sign of an inadequate post-operative level of physical activity and lack of exercise training. This stresses the importance of post-operative management and methods for increasing aerobic capacity, where exercise testing could be valuable for guiding patients and tailoring exercise protocols. The eccentric cardiac hypertrophy in ATH, symmetri...

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Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes

Abstract: Regional deformation and deformation rates (TDI and 2DSE) are reduced in the basal RV segment in athletes. This phenomenon is most pronounced in athletes with RV dilatation and should be interpreted as normal when evaluating athletes suspected for RV pathology.

Cited by 135 publications

References 31 publications

Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers

Cardiac function and long-term volume load : Physiological investigations in endurance athletes and in patients operated on for aortic regurgitation

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