Physical Activity and Right Ventricular Structure and Function

Aaron, Carrie P.; Tandri, Harikrishna; Barr, R. Graham; Johnson, W. Craig; Bagiella, Emilia; Chahal, Harjit; Jain, Aditya; Kizer, Jorge R.; Bertoni, Alain G.; Lima, João A.C.; Bluemke, David A.; Kawut, Steven M.

doi:10.1164/rccm.201003-0469oc

Cited by 69 publications

(28 citation statements)

References 33 publications

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“… 23 – 27 while others have reported normal RV function. 19 , 28 In the present study, ARVC athletes had clearly dilated RV dimensions and severely reduced RV function. 19 , 29 Combined, our findings showed reduced LV and RV function in ARVC athletes compared with ARVC non-athletes.…”

Section: Discussionsupporting

confidence: 52%

Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members

Saberniak

Hasselberg

Borgquist

et al. 2014

European J of Heart Fail

216

138

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AimsExercise increases risk of ventricular arrhythmia in subjects with arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed to investigate the impact of exercise on myocardial function in ARVC subjects.Methods and ResultsWe included 110 subjects (age 42 ± 17 years), 65 ARVC patients and 45 mutation-positive family members. Athletes were defined as subjects with ≥4 h vigorous exercise/week [≥1440 metabolic equivalents (METs × minutes/week)] during a minimum of 6 years. Athlete definition was fulfilled in 37/110 (34%) subjects. We assessed right ventricular (RV) and left ventricular (LV) myocardial function by echocardiography, and by magnetic resonance imaging (MRI). The RV function by RV fractional area change (FAC), RV global longitudinal strain (GLS) by echocardiography, and RV ejection fraction (EF) by MRI was reduced in athletes compared with non-athletes (FAC 34 ± 9% vs. 40 ± 11%, RVGLS –18.3 ± 6.1% vs. –22.0 ± 4.8%, RVEF 32 ± 8% vs. 43 ± 10%, all P < 0.01). LV function by LVEF and LVGLS was reduced in athletes compared with non-athletes (LVEF by echocardiography 50 ± 10% vs. 57 ± 5%, LVEF by MRI 46 ± 6% vs. 53 ± 8%, and LVGLS –16.7 ± 4.2% vs. –19.4 ± 2.9%, all P < 0.01). The METs × minutes/week correlated with reduced RV and LV function by echocardiography and MRI (all P < 0.01). The LVEF by MRI was also reduced in subgroups of athlete index patients (46 ± 7% vs. 54 ± 10%, P = 0.02) and in athlete family members (47 ± 3% vs. 52 ± 6%, P < 0.05).ConclusionAthletes showed reduced biventricular function compared with non-athletes in ARVC patients and in mutation-positive family members. The amount and intensity of exercise activity was associated with impaired LV and RV function. Exercise may aggravate and accelerate myocardial dysfunction in ARVC.

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Section: Discussionsupporting

confidence: 52%

Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members

Saberniak

Hasselberg

Borgquist

et al. 2014

European J of Heart Fail

216

138

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“…While the effect sizes seem small (ranging from 3.2% to 5.5%), they are comparable to those seen in the LV related to active smoking and diabetes mellitus and in the RV related to physical activity (e.g., a 7% increase in RVEDV and a 5% increase in RV mass with higher levels of physical activity), but more subtle than the associations we have shown in the RV related to obesity [54], [55], [56]. A few small studies have shown similar magnitudes of effect on RV tissue Doppler imaging [57], [58], [59].…”

Section: Discussionsupporting

confidence: 66%

Selective Serotonin Reuptake Inhibitor Use Is Associated with Right Ventricular Structure and Function: The MESA-Right Ventricle Study

et al. 2012

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PurposeSerotonin and the serotonin transporter have been implicated in the development of pulmonary hypertension (PH). Selective serotonin reuptake inhibitors (SSRIs) may have a role in PH treatment, but the effects of SSRI use on right ventricular (RV) structure and function are unknown. We hypothesized that SSRI use would be associated with RV morphology in a large cohort without cardiovascular disease (N = 4114).MethodsSSRI use was determined by medication inventory during the Multi-Ethnic Study of Atherosclerosis baseline examination. RV measures were assessed via cardiac magnetic resonance imaging. The cross-sectional relationship between SSRI use and each RV measure was assessed using multivariable linear regression; analyses for RV mass and end-diastolic volume (RVEDV) were stratified by sex.ResultsAfter adjustment for multiple covariates including depression and left ventricular measures, SSRI use was associated with larger RV stroke volume (RVSV) (2.75 mL, 95% confidence interval [CI] 0.48–5.02 mL, p = 0.02). Among men only, SSRI use was associated with greater RV mass (1.08 g, 95% CI 0.19–1.97 g, p = 0.02) and larger RVEDV (7.71 mL, 95% 3.02–12.40 mL, p = 0.001). SSRI use may have been associated with larger RVEDV among women and larger RV end-systolic volume in both sexes.ConclusionsSSRI use was associated with higher RVSV in cardiovascular disease-free individuals and, among men, greater RV mass and larger RVEDV. The effects of SSRI use in patients with (or at risk for) RV dysfunction and the role of sex in modifying this relationship warrant further study.

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“…While self-reported physical activity has previously been associated with higher LV mass and larger LV end diastolic volume (25-28), there are few studies that have comprehensively addressed the association between measured fitness and echocardiographic measures of LV structure and function in middle-aged adults (29). To our knowledge, this is the first paper to examine the association between measured cardiorespiratory fitness and echocardiographic measures of both LV structure and function in a large cohort of healthy, asymptomatic, middle-aged adults not referred for exercise testing.…”

Section: Discussionmentioning

confidence: 99%

Association of Cardiorespiratory Fitness With Left Ventricular Remodeling and Diastolic Function

Brinker

Pandey

Ayers

et al. 2014

JACC: Heart Failure

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Objectives To compare the cross-sectional associations between cardiorespiratory fitness and echocardiographic measures of cardiac structure and function. Background Cardiorespiratory fitness (fitness) is inversely associated with heart failure risk. However, the mechanism through which fitness lowers heart failure risk is not fully understood. Methods We included 1,678 men and 1,247 women from the Cooper Center Longitudinal Study who received an echocardiogram from 1999—2011. Fitness was measured by Balke protocol and categorized into age-specific quartiles with quartile 1 representing low fitness. Cross sectional associations between fitness (in METs) and relative wall thickness (RWT), left ventricular end-diastolic diameter indexed to body surface area (LVEDD/BSA), left atrial volume indexed to body surface area (LA Vol/BSA), left ventricular systolic function (LVEF), and E/e′ ratio were determined using multivariable linear regression analysis. Results Higher levels of mid life fitness (METs) was associated with larger indexed LA volume (Men: β = 0.769, p <0.0001; Women: β = 0.879, p value = <0.0001) and indexed LVEDD (Men: β = 0.231, p <0.001; Women: β = 0.264, p <0.0001). Similarly, a higher level of fitness was associated with a smaller RWT (Men: β = -0.002; p = 0.04; Women: β = -0.005, p <0.0001) and E/e′ ratio (Men: β = -0.11; p = 0.003; Women: β = -0.13, p value = 0.01). However, there was no association between low fitness and LVEF (P=NS). Conclusions Low fitness is associated with a higher prevalence of concentric remodeling and diastolic dysfunction, suggesting that exercise may lower heart failure risk through its effect on favorable cardiac remodeling and improved diastolic function.

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Physical Activity and Right Ventricular Structure and Function

Abstract: Higher levels of physical activity in adults were associated with greater RV mass independent of the associations with LV mass; similar results were found for RV volumes. Exercise-associated RV remodeling may have important clinical implications.

Cited by 69 publications

References 33 publications

Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members

Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members

Selective Serotonin Reuptake Inhibitor Use Is Associated with Right Ventricular Structure and Function: The MESA-Right Ventricle Study

Association of Cardiorespiratory Fitness With Left Ventricular Remodeling and Diastolic Function

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