Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

Abstract

Background Reference values for right ventricular function and pulmonary circulation coupling were recently established for the general population. However, normative values for elite athletes are missing, even though exercise-related right ventricular enlargement is frequent in competitive athletes. Methods We examined 497 healthy male elite athletes (age 26.1 ± 5.2 years) of mixed sports with a standardized transthoracic echocardiographic examination. Tricuspid annular plane excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Pulmonary circulation coupling was calculated as TAPSE/SPAP ratio. Two age groups were defined (18–29 years and 30–39 years) and associations of clinical parameters with the TAPSE/SPAP ratio were determined and compared for each group. Results Athletes aged 18–29 (n = 349, 23.8 ± 3.5 years) displayed a significantly lower TAPSE/SPAP ratio (1.23 ± 0.3 vs. 1.31 ± 0.33 mm/mmHg, p = 0.039), TAPSE/SPAP to body surface area (BSA) ratio (0.56 ± 0.14 vs. 0.6 ± 0.16 mm*m2/mmHg, p = 0.017), diastolic blood pressure (75.6 ± 7.9 vs. 78.8 ± 10.7 mmHg, p < 0.001), septal wall thickness (10.2 ± 1.1 vs. 10.7 ± 1.1 mm, p = 0.013) and left atrial volume index (27.5 ± 4.5 vs. 30.8 ± 4.1 ml/m2, p < 0.001), but a higher SPAP (24.2 ± 4.5 vs. 23.2 ± 4.4 mmHg, p = 0.035) compared to athletes aged 30–39 (n = 148, 33.1 ± 3.4 years). TAPSE was not different between the age groups. The TAPSE/SPAP ratio was positively correlated with left ventricular stroke volume (r = 0.133, p = 0.018) and training amount per week (r = 0.154, p = 0.001) and negatively correlated with E/E′ lat. (r = −0.152, p = 0.005). Conclusion The reference values for pulmonary circulation coupling determined in this study could be used to interpret and distinguish physiological from pathological cardiac remodeling in male elite athletes.

Assessment of Pulmonary Arteries Hemodynamics and Its Relationship With Cardiac Remodeling and Myocardial Fibrosis in Athletes With Four‐Dimensional Flow MRI

“…12,13 Ultrasound, catheterization, and cardiac MRI are the primary modalities employed for assessing cardiac and pulmonary arterial hemodynamics. 7,8,[10][11][12][13][14][15][16][17][18] Four-dimensional (4D) flow MRI is a promising non-invasive technique for evaluating blood flow velocity and volume with high consistency, with results comparable to catheterization. 13 It offers improved accuracy and comprehensiveness compared to echocardiography and to two-dimensional phase-contrast MRI, and has found widespread application in various cardiovascular conditions.…”

“…[15][16][17] However, most cardiovascular studies on athletes were based on ultrasound and two-dimensional phase-contrast MRI, and the obtained hemodynamic parameters were limited. 8,13,18 Additionally, late gadolinium enhancement (LGE) sequence was solely performed in previous cardiovascular MRI studies, thus limiting the analysis of relationship between MF and hemodynamic characteristics induced by exercise. 7,[11][12][13]18 Thus, the aim of this study was to evaluate the hemodynamics of pulmonary arteries in athletes using 4D flow MRI and its relationship with CR and/or MF by combining the machine learning (ML) methods.…”

“…Ultrasound, catheterization, and cardiac MRI are the primary modalities employed for assessing cardiac and pulmonary arterial hemodynamics 7,8,10–18 . Four‐dimensional (4D) flow MRI is a promising non‐invasive technique for evaluating blood flow velocity and volume with high consistency, with results comparable to catheterization 13 .…”

“…It offers improved accuracy and comprehensiveness compared to echocardiography and to two‐dimensional phase‐contrast MRI, and has found widespread application in various cardiovascular conditions 15–17 . However, most cardiovascular studies on athletes were based on ultrasound and two‐dimensional phase‐contrast MRI, and the obtained hemodynamic parameters were limited 8,13,18 . Additionally, late gadolinium enhancement (LGE) sequence was solely performed in previous cardiovascular MRI studies, thus limiting the analysis of relationship between MF and hemodynamic characteristics induced by exercise 7,11–13,18 …”

“…However, most cardiovascular studies on athletes were based on ultrasound and two‐dimensional phase‐contrast MRI, and the obtained hemodynamic parameters were limited 8,13,18 . Additionally, late gadolinium enhancement (LGE) sequence was solely performed in previous cardiovascular MRI studies, thus limiting the analysis of relationship between MF and hemodynamic characteristics induced by exercise 7,11–13,18 …”