Exercise-induced shift in right ventricular contraction pattern: novel marker of athlete’s heart?

Lakatos, Bálint Károly; Kiss, Orsolya; Tokodi, Márton; Tősér, Zoltán; Sydó, Nóra; Merkely, Gergő; Babity, Máté; Szilágyi, M.; Komócsin, Zsuzsanna; Bognár, Csaba; Kovács, Attila; Merkely, Béla

doi:10.1152/ajpheart.00304.2018

Cited by 26 publications

(31 citation statements)

References 45 publications

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“…Under physiological conditions, the longitudinal shortening was suggested to account for the majority of RV pump function [ 5 ]; however, the majority of recent studies suggest a similar importance of longitudinal and radial motions (Fig. 2 ) [ 6 , 7 ]. Larger studies are needed to characterize potential age-related and gender-related alterations.…”

Section: Functional Pattern Of Rv Myocardial Mechanicsmentioning

confidence: 99%

“…Although very few prospective follow-up studies were performed in the field, current data suggest that the volumetric adaptation of the RV to exercise is more pronounced than that of the LV and that the eccentric type of hypertrophy is expected at all levels of training [ 53 ]. Resting global RV function is often in the low-normal range and data suggests a relative decrease in radial shortening along with maintained or increased longitudinal function [ 7 , 54 ]. Following ultraendurance sport events, however, the RV dimensions may increase, and decreased ejection fractions and GLS can be seen [ 54 ].…”

Section: Athlete’s Heartmentioning

confidence: 99%

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Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

et al. 2019

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Right ventricular (RV) function has proven to be a prognostic factor in heart failure with reduced and preserved ejection fraction and in pulmonary hypertension. RV function is also a cornerstone in the management of novel clinical issues, such as mechanical circulatory support devices or grown-up congenital heart disease patients. Despite the notable amount of circumferentially oriented myofibers in the subepicardial layer of the RV myocardium, the non-longitudinal motion directions are often neglected in the everyday assessment of RV function by echocardiography. However, the complex RV contraction pattern incorporates different motion components along three anatomically relevant axes: longitudinal shortening with traction of the tricuspid annulus towards the apex, radial motion of free wall often referred as the “bellows effect”, and anteroposterior shortening of the chamber by stretching the free wall over the septum. Advanced echocardiographic techniques, such as speckle-tracking and 3D echocardiography allow an in-depth characterization of RV mechanical pattern, providing better understanding of RV systolic and diastolic function. In our current review, we summarize the existing knowledge regarding RV mechanical adaptation to pressure- and/or volume-overloaded states and also other physiologic or pathologic conditions.

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Section: Functional Pattern Of Rv Myocardial Mechanicsmentioning

confidence: 99%

Section: Athlete’s Heartmentioning

confidence: 99%

Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

et al. 2019

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“…By decomposing the model's motion along the three orthogonal anatomically relevant axes, volume loss attributable to either longitudinal or radial wall motions could be separately quantified. Thus, longitudinal EF (LEF), radial EF (REF) and their ratios to global RVEF [LEF index (LEFi) = LEF/RVEF, and REF index (REFi) = REF/RVEF] could be expressed as a measure of the relative contribution of the given direction to global function.To assess longitudinal and circumferential myocardial deformation, we computed 3D RVGLS and RVGCS as described elsewhere 15. …”

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confidence: 99%

“…The magnitude of EROA and regurgitant volume were associated with RV geometrical remodelling (RVEDVi vs. EROA: β = 0.41, R 2 = 0.15, P = 0.034; RVEDVi vs. regurgitant volume: β = 0.57, R 2 = 0.31, P < 0.001). Pre-operatively measured CVP, mPAP, PAWP, PVR, and DPG were 13[10][11][12][13][14][15][16] mmHg, 28 [21-36] mmHg, 17 [14-23] mmHg, 2.5 [1.8-3.5] Wood units, and 3 [1-…”

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confidence: 99%

Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?

et al. 2020

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Aims The PREPARE-MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair (MVR) and to explore the associations between pre-operative RV mechanics and early post-operative RV dysfunction (RVD). Methods and resultsWe prospectively enrolled 42 patients (63 ± 11 years, 69% men) undergoing open-heart MVR. Transthoracic three-dimensional (3D) echocardiography was performed pre-operatively, at intensive care unit discharge, and 6 months after surgery. The 3D model of the RV was reconstructed, and RV ejection fraction (RVEF) was calculated. We decomposed the motion of the ventricle to compute longitudinal ejection fraction (LEF) and radial ejection fraction (REF). Pulmonary artery catheterization was performed to monitor RV stroke work index (RVSWi). RVEF was slightly decreased after vs. 51 (46-54)%; P = 0.001], whereas RV contraction pattern changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic RV function [LEF/RVEF vs. REF/RVEF; 0.53 (0.47-0.58) vs. 0.33 (0.22-0.42); P < 0.001]. Post-operatively, the radial motion became dominant [0.33 (0.28-0.43) vs. 0.46 (0.37-0.51); P = 0.004].However, this shift was temporary as 6 months later the two components contributed equally to global RV function [0.44 (0.38-0.50) vs. 0.41 (0.36-0.49); P = 0.775]. Pre-operative LEF was an independent predictor of post-operative RVD defined as RVSWi < 300 mmHgÁmL/m 2 [OR = 1.33 (95% CI: 1.08-1.77), P < 0.05]. Conclusions MVR induces a significant shift in the RV mechanical pattern. Advanced indices of RV mechanics are associated with invasively measured parameters of RV contractility and may predict post-operative RVD.

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“…The most pronounced structural changes have been observed in elite, competitive athletes; typically, biatrial and biventricular enlargement and/or hypertrophy are observed. [1][2][3] Functional measurements often result in low-normal values at rest. 1,4 Despite the pronounced cardiac remodeling in athletes, it is still a matter of debate whether exercise capacity can be predicted by cardiac size or by resting functional measurements.…”

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confidence: 99%

Relationship between Cardiac Remodeling and Exercise Capacity in Elite Athletes: Incremental Value of Left Atrial Morphology and Function Assessed by Three-Dimensional Echocardiography

Lakatos

Molnár

Kiss

et al. 2020

Journal of the American Society of Echocardiography

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Background: Data are scarce regarding left atrial (LA) adaptation to regular physical exercise. The aim of this study was to examine left ventricular (LV) and also LA morphologic and functional remodeling in elite athletes using three-dimensional (3D) echocardiography. Methods: In this retrospective analysis, the study group consisted of 138 elite athletes (mean age, 20 6 4 years; 62% men) and 50 sedentary control subjects. Electrocardiographically gated full-volume 3D data sets were obtained for offline analysis using dedicated software for 3D LA and LV measurements. Body surface areaindexed LA maximal volume (LAVmax) and LV end-diastolic volume were determined. LA total emptying fraction, LA passive and LA active emptying fraction, and LV global longitudinal strain were also calculated. Athletes also underwent cardiopulmonary exercise testing to determine peak oxygen uptake. Results: Athletes demonstrated higher 3D LAVmax (32 6 6 vs 26 6 8 mL/m 2) and indexed LV end-diastolic volume (85 6 12 vs 62 6 10 mL/m 2) compared with control subjects (P < .001 for both). Functional measures of the left ventricle and left atrium, such as the absolute value of 3D LV global longitudinal strain (19 6 2% vs 22 6 2%), LA total emptying fraction (58 6 6% vs 64 6 6%), and active emptying fraction (24 6 10% vs 32 6 10%) were lower in athletes (P < .001 for all). Male athletes had higher indexed LV end-diastolic volume compared with female athletes (89 6 13 vs 80 6 8 mL/m 2 , P < .001), but LAVmax did not differ between genders (32 6 6 vs 33 6 5 mL/m 2 , P = .18). Besides heart rate, gender, and body surface area, 3D LAVmax, LV global longitudinal strain, and LA passive emptying fraction were independent predictors of peak oxygen uptake. Conclusions: Regular physical exercise results in marked LA and LV remodeling with considerable gender differences as explored by 3D echocardiography. In contrast with various cardiovascular diseases, more pronounced LA dilation and lower resting functional measures are associated with better exercise performance.

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Exercise-induced shift in right ventricular contraction pattern: novel marker of athlete’s heart?

Cited by 26 publications

References 45 publications

Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?

Relationship between Cardiac Remodeling and Exercise Capacity in Elite Athletes: Incremental Value of Left Atrial Morphology and Function Assessed by Three-Dimensional Echocardiography

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