Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes

Gerche, André La; Claessen, Guido; Dymarkowski, Steven; Voigt, Jens‐Uwe; Buck, Frederik De; Vanhees, Luc; Droogné, Walter; Cleemput, Johan Van; Claus, Piet; Heidbüchel, Hein

doi:10.1093/eurheartj/ehv202

Cited by 155 publications

(100 citation statements)

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“…There is growing appreciation that right ventricular (RV) dysfunction is related to adverse outcomes [11–13]. RV remodeling (larger RV mass and volumes) and impaired systolic and diastolic function have been documented in overweight and obese adults [14–17].…”

Section: Introductionmentioning

confidence: 99%

Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study

Jing

Pulenthiran

Nevius

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundPediatric obesity is a growing public health problem, which is associated with increased risk of cardiovascular disease and premature death. Left ventricular (LV) remodeling (increased myocardial mass and thickness) and contractile dysfunction (impaired longitudinal strain) have been documented in obese children, but little attention has been paid to the right ventricle (RV). We hypothesized that obese/overweight children would have evidence of RV remodeling and contractile dysfunction.MethodsOne hundred and three children, ages 8–18 years, were prospectively recruited and underwent cardiovascular magnetic resonance (CMR), including both standard cine imaging and displacement encoding with stimulated echoes (DENSE) imaging, which allowed for quantification of RV geometry and function/mechanics. RV free wall longitudinal strain was quantified from the end-systolic four-chamber DENSE image. Linear regression was used to quantify correlations of RV strain with LV strain and measurements of body composition (adjusted for sex and height). Analysis of variance was used to study the relationship between RV strain and LV remodeling types (concentric remodeling, eccentric/concentric hypertrophy).ResultsThe RV was sufficiently visualized with DENSE in 70 (68%) subjects, comprising 36 healthy weight (13.6 ± 2.7 years) and 34 (12.1 ± 2.9 years) obese/overweight children. Obese/overweight children had a 22% larger RV mass index (8.2 ± 0.9 vs 6.7 ± 1.1 g/m2.7, p < 0.001) compared to healthy controls. RV free wall longitudinal strain was impaired in obese/overweight children (−16 ± 4% vs −19 ± 5%, p = 0.02). Ten (14%) out of 70 children had LV concentric hypertrophy, and these children had the most impaired RV longitudinal strain compared to those with normal LV geometry (−13 ± 4% vs −19 ± 5%, p = 0.002). RV longitudinal strain was correlated with LV longitudinal strain (r = 0.34, p = 0.004), systolic blood pressure (r = 0.33, p = 0.006), as well as BMI z-score (r = 0.28, p = 0.02), waist (r = 0.31, p = 0.01), hip (r = 0.40, p = 0.004) and abdominal (r = 0.38, p = 0.002) circumference, height and sex adjusted.ConclusionsObese/overweight children have evidence of RV remodeling (increased RV mass) and RV contractile dysfunction (impaired free wall longitudinal strain). Moreover, RV longitudinal strain correlates with LV longitudinal strain, and children with LV concentric hypertrophy show the most impaired RV function. These results suggest there may be a common mechanism underlying both remodeling and dysfunction of the left and right ventricles in obese/overweight children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0363-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study

Jing

Pulenthiran

Nevius

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…Le ventricule droit est plus concerné que le gauche. Ses altéra-tions fonctionnelles plus nettes sont de plus associées à une dilatation qui persiste quelques heures après l'effort [20]. Le ventricule droit a été pendant longtemps « l'oublié » de la cardiologie du sport.…”

Section: La Fatigue Myocardiqueunclassified

“…Pourtant sa physiologie à l'effort diffère de celle du ventricule gauche. En effet, la contrainte hémody-namique imposée au ventricule droit est proportionnellement plus importante que celle du ventricule gauche [20]. Or, le ventricule droit du fait de son origine embryologique différente, de sa fonction basale (éjecter le sang dans la circulation pulmonaire pour son oxygénation) simple, et de sa paroi mince peu musclée est clairement moins bien armé que le ventricule gauche pour répondre aux contraintes d'un effort intense et prolongé [1].…”

Section: La Fatigue Myocardiqueunclassified

“…Son apparition impose une diminution de la pratique sportive. La création sur un coeur préalablement sain par la seule pratique sportive d'hyper-endurance de foyers arythmogènes ventriculaires en particulier au niveau du ventricule droit a aussi été proposée [20] mais elle reste discutée [27]. À notre connaissance il n'a pas encore été décrit de dysfonction ventriculaire chronique sur coeur parfaitement sain formellement et uniquement imputable à la seule pratique d'une activité sportive intense.…”

Section: La Cardiomyopathie De Phidippidesunclassified

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Actualité en cardiologie du sport : trop de sport peut-il être néfaste pour le cœur ?

Carré

2015

La Presse Médicale

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“…Some studies have found RV and right atrium (RA) enlargement in elite athletes (Henriksen et al, 1996; Erol and Karakelleoglu, 2002). While in recent years participation in endurance sports has increased, several concerns have been raised about the harmful effects these sports may have on cardiac morphology and function and the risk of cardiac arrhythmias (Calvo et al, 2012; La Gerche et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

Enhanced Right-Chamber Remodeling in Endurance Ultra-Trail Athletes Compared to Marathon Runners Detected by Standard and Speckle-Tracking Echocardiography

Ujka¹,

Bastiani²,

D’Angelo³

et al. 2017

Front. Physiol.

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Background: Strenuous and endurance exercise training have been associated with morphological and functional heart remodeling. Two-dimensional speckle-tracking echocardiography (STE) is a novel technique that allows an accurate quantification of global myocardium deformation. Our aim was to evaluate together left and right cardiac remodeling in different long-distance running athletes: marathon runners (42 km) (M) and endurance mountain runners (>300 Km) (UT).Methods: A total of 92 athletes (70 males, 76%) including 47 M [age 45 ± 7 years; training: 18 (9–53) years*days/week], 45 UT [age 42 ± 9, training: 30 (15–66) years*days/week] underwent conventional echocardiography and STE (Beyond Diogenes 2.0, AMID) during the agonistic season.Results: Right ventricle (RV) end-diastolic area (p = 0.026), fractional area changing (FAC) (p = 0.008) and RV global longitudinal strain (GLS) were significantly increasedin UT athletes. Furthermore, UT showed larger right atrium (RA) volume (p = 0.03), reduced RA GLS and significantly increased RA global circumferential strain (GCS) compared to M. After adjustment for age, sex, and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856–0.961) and increased RV FAC (OR 1.172; CI: 1.044–1.317) compared to M.Conclusion: Athletes enrolled in UT endurance activities showed RV and RA morphological and functional remodeling to increased preload in comparison with M runners characterized by increased RV FAC and reduced RA GLS. Follow-up studies are needed to better assess the long-term clinical impact of these modifications. 2D STE is a useful tool for investigating the deformation dynamic in different sports specialties.

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Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes

Abstract: Among athletes with normal cardiac function at rest, exercise testing reveals RV contractile dysfunction among athletes with RV arrhythmias. RV stress testing shows promise as a non-invasive means of risk-stratifying athletes.

Cited by 155 publications

References 29 publications

Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study

Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study

Actualité en cardiologie du sport : trop de sport peut-il être néfaste pour le cœur ?

Enhanced Right-Chamber Remodeling in Endurance Ultra-Trail Athletes Compared to Marathon Runners Detected by Standard and Speckle-Tracking Echocardiography

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