Right ventricular strain rate during exercise accurately identifies male athletes with right ventricular arrhythmias

Claeys, Mathias; Claessen, Guido; Claus, Piet; Bosscher, Ruben De; Dausin, Christophe; Voigt, Jens‐Uwe; Heidbüchel, Hein; Gerche, André La

doi:10.1093/ehjci/jez228

Cited by 16 publications

(20 citation statements)

References 32 publications

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“…SR is relatively more independent of HR, structure, and loading conditions than strain and diameter 26 . Hence, SR might better re ect the training responses and appears to be the more accurate parameter in myocardial contractility, especially during exercise 27 . In addition to the context of loading and structure, in some hypoxiasusceptible patients, RV dysfunction has been suggested to be caused by a direct negative inotropic effect of hypoxia on cardiac myocytes and decreased oxygenation 28 .…”

Section: Discussionmentioning

confidence: 99%

High-intensity Interval Training Enhances Hypoxia-mediated Right Cardiac Mechanics in Sedentary Men

Huang¹,

Hsu²,

Fu³

2020

Preprint

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Purpose: Hypoxic exposure increases right ventricular (RV) afterload by triggering pulmonary hypertension, with consequent effects on the structure and function of the right ventricle. Improved myocardial contractility is a critical circulatory adaptation to exercise training. However, the types of exercise that enhance right cardiac mechanics during hypoxic stress have not yet been identified. This study investigated how high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) influence right cardiac mechanics during hypoxic exercise (HE). Methods: A total of 54 young and healthy sedentary males were randomly selected to engage in either HIIT (3-min intervals at 40% and 80% of VO2max, n = 18) or MICT (sustained 60% of VO2max, n = 18) for 30 min/day and 5 days/week for 6 weeks or were included in a control group (CTL, n = 18) that did not engage in any exercise. Right cardiac mechanics during semiupright bicycle exercise tests under hypoxic conditions (i.e., 50 watts under 12% FIO2 for 3 min) were measured using two-dimensional speckle-tracking echocardiography. Results: After 6 weeks of training, HIIT was superior to MICT in improving VO2max. Furthermore, the HIIT group showed reduced pulmonary vascular resistance (PVR) as well as an elevated RV ejection fraction (RVEF) under hypoxia, coupled with a significant enhancement of the right atrial (RA) reservoir and conduit functions. HIIT is superior to MICT in dilating the right ventricle and ameliorating radial strain rate but reducing radial strain in either systole or diastole. In the correlation analysis, the changes in RVEF were directly associated with improved RA reservoir and conduit functions but inversely associated with the change in radial RV strain caused by HIIT. Conclusion: HIIT is superior to MICT in improving right cardiac mechanics by simultaneously increasing RA reservoir and conduit functions and decreasing PVR during HE.

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Section: Discussionmentioning

confidence: 99%

High-intensity Interval Training Enhances Hypoxia-mediated Right Cardiac Mechanics in Sedentary Men

Huang¹,

Hsu²,

Fu³

2020

Preprint

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“…ExS’ correlated well with peak VO 2 23,24 , and was a significant predictor of all-cause mortality and HF hospitalization 25 . Also, right ventricular S’ was demonstrated to be a useful marker of longitudinal function during exercise, and was able to identify athletes at risk of arrythmias 26 .…”

Section: Discussionmentioning

confidence: 99%

Novel echocardiographic markers of elevated left ventricular filling pressure during diastolic stress testing

Verwerft

Verbrugge

Claessen

et al. 2020

Preprint

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AimsDiastolic stress testing (DST) is recommended to confirm heart failure with preserved ejection fraction (HFpEF) in patients with exertional dyspnea, but algorithms lack sensitivity. We aimed to identify additional echocardiographic markers of elevated pulmonary arterial wedge pressure during exercise (exPAWP) in patients referred for DST.Methods and ResultsWe analyzed 22 patients referred for exercise right heart catheterization with simultaneous echocardiography. We identified candidate parameters in patients with exPAWP ≥25 mmHg. Elevated exPAWP was present in 14 patients, and was best identified by peak septal systolic annular velocity on color Doppler (exS’, area under the receiver operating characteristic curve (AUC) 0.97, 95% confidence interval 0.92-1.0) and mean pulmonary artery pressure/cardiac output slope (mPAP/CO, AUC 0.88 [0.72-1.0]). We propose a three-step decision tree to identify patients with elevated exPAWP. Applying this decision tree to 376 patients in an independent non-invasive DST cohort showed that patients labeled as ‘high probability of HFpEF’ had reduced peak oxygen uptake (12.8 (10.5-15.9) mL/kg/min, p<.001 vs intermediate/low probability), high H2FPEF score (55 (44-75)%, p<.007 vs intermediate/low probability), and typical clinical characteristics. The amount of inconclusive DST decreased from 80% using current recommendations, to 29% using the decision tree.ConclusionIn DST for suspected HFpEF, exS’ was the most accurate echocardiographic parameter to identify elevated PAWP. We propose a decision tree including exS’ and mPAP/CO for interpretation of DST. Application of this decision tree revealed typical HFpEF characteristics in patients labeled as high probability of HFpEF, and substantially reduced the amount of inconclusive results.

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“…57,58 However, over the past decade, there has been a better understanding of the clinical features of cardiomyopathies in athletes; in particular, a clarification of natural history of the disease process in patients with ARVC, novel diagnostic methods, as well as the emergence of a genotype-phenotype relationship in cardiomyopathies, have been important developments. 19,20,60,61 Among phenotypical ARVC presentation, the recommendations clearly advise against competitive sports participation. [62][63][64] For athletes with a definite diagnosis of ARVC, the 2015 scientific statement from the American Heart Association and…”

Section: Evolution Of Recommendations Regarding Exercise Participatmentioning

confidence: 99%

“…The European guidelines were more restrictive and considered that competitive sport could play a role in the progression of the phenotype of ARVC, especially in the presence of a predisposing gene mutation 57,58 . However, over the past decade, there has been a better understanding of the clinical features of cardiomyopathies in athletes; in particular, a clarification of natural history of the disease process in patients with ARVC, novel diagnostic methods, as well as the emergence of a genotype‐phenotype relationship in cardiomyopathies, have been important developments 19,20,60,61 . Among phenotypical ARVC presentation, the recommendations clearly advise against competitive sports participation 62‐64 .…”

Section: Evolution Of Recommendations Regarding Exercise Participatiomentioning

confidence: 99%

The arrhythmogenic right ventricular cardiomyopathy in comparison to the athletic heart

Mascia

Arbelo

Porto

et al. 2020

Cardiovasc electrophysiol

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Intense exercise‐induced right ventricular remodeling is a potential adaptation of cardiac function and structure. The features of the remodeling may overlap with those of a very early form of arrhythmogenic right ventricular cardiomyopathy (ARVC): at this early stage, it could be difficult to discriminate ARVC, from exercise‐induced cardiac adaptation that may develop in normal individuals. The purpose of this paper is to discuss which exercise‐induced remodeling may be a pathological or a physiological finding. A complete evaluation may be required to identify the pathological features of ARVC that would include potential risk of sudden cardiac death during sport or, to avoid the false diagnosis of ARVC. The most recent expert assessment of arrhythmogenic cardiomyopathy focuses on endurance athletes presenting with clinical features indistinguishable from ARVC.

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Right ventricular strain rate during exercise accurately identifies male athletes with right ventricular arrhythmias

Cited by 16 publications

References 32 publications

High-intensity Interval Training Enhances Hypoxia-mediated Right Cardiac Mechanics in Sedentary Men

High-intensity Interval Training Enhances Hypoxia-mediated Right Cardiac Mechanics in Sedentary Men

Novel echocardiographic markers of elevated left ventricular filling pressure during diastolic stress testing

The arrhythmogenic right ventricular cardiomyopathy in comparison to the athletic heart

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