Range of right heart measurements in top-level athletes: The training impact

D’Andrea, Antonello; Riegler, Lucia; Golia, Enrica; Cocchia, Rosangela; Scarafile, Raffaella; Salerno, Gemma; Pezzullo, Enrica; Nunziata, Luigi; Citro, Rodolfo; Cuomo, Sergio; Caso, Pio; Salvo, Giovanni Di; Cittadini, Antonio; Russo, Maria Giovanna; Calabrò, Raffaele; Bossone, Eduardo

doi:10.1016/j.ijcard.2011.06.058

Cited by 145 publications

(74 citation statements)

References 43 publications

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“…There is strong evidence supporting the disproportionate increase in right heart size in endurance athletes (D'Andrea et al 2012;Oxborough et al 2012) but this appears to be physiological in nature. There is however a school of thought that repeated exposure and insufficient recovery time may lead to an acute phenomenon of RV adaptation acting as a stimulus for pathological adaptation (La Gerche et al 2011b).…”

Section: Discussionmentioning

confidence: 99%

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

et al. 2014

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Purpose: There is contradictory evidence related to the impact of ultra-marathon running on right ventricular (RV) structure and function. Consequently, the aims of this study were to; 1) comprehensively assess RV structure and function before and immediately following a 100 mile ultramarathon in highly trained runners, 2) determine the nature of RV recovery 6 hours post-race, and 3) document 12-lead electrocardiogram (ECG) changes post-exercise.Methods: Echocardiography and 12-lead ECG were assessed in 15 competitors in a repeated measures design before and immediately after completion of the 2013 Western States Endurance Race. A subset of 9 were reassessed 6 hours into recovery. Standard echocardiography was used to determine RV size, function and wall stress. Myocardial speckle tracking (MST) provided peak, time to peak and temporal indices for RV longitudinal strain and strain rates (ε and SR).Results: RV size was increased post-race (inflow tract 14 %, outflow tract 11 %, P = 0.004 and 0.002). RV wall stress was elevated by 11 % post-race. Peak RV ε was reduced by 10 % (P = 0.007) and significantly delayed post-race (P = 0.008). Most changes in RV function persisted at the 6 hour assessment. Post-race there was an increase in the prevalence of right-sided ECG changes. Conclusions:Completion of a 100 mile ultra-marathon resulted in acute changes in RV structure and function that persisted 6 hours into recovery and are consistent with sustained exposure to an elevated RV wall stress. These findings were supported by right sided changes to the 12-Lead ECG.

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Section: Discussionmentioning

confidence: 99%

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

et al. 2014

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“…not detect any evidence of myocardial RV damage in endurance athletes, 11,[13][14][15] and increases in biomarkers are not necessarily linked to RV injury because the exercise-induced increases could also reflect a physiological mechanism. 16 Therefore, to date, long-term clinical consequences caused by repeated intensive endurance exercise remain speculative.…”

Section: May 17 2016mentioning

confidence: 94%

Right and Left Ventricular Function and Mass in Male Elite Master Athletes

et al. 2016

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Background— It is under debate whether the cumulative effects of intensive endurance exercise induce chronic cardiac damage, mainly involving the right heart. The aim of this study was to examine the cardiac structure and function in long-term elite master endurance athletes with special focus on the right ventricle by contrast-enhanced cardiovascular magnetic resonance. Methods and Results— Thirty-three healthy white competitive elite male master endurance athletes (age range, 30–60 years) with a training history of 29±8 years, and 33 white control subjects pair-matched for age, height, and weight underwent cardiopulmonary exercise testing, echocardiography including tissue-Doppler imaging and speckle tracking, and cardiovascular magnetic resonance. Indexed left ventricular mass and right ventricular mass (left ventricular mass/body surface area, 96±13 and 62±10 g/m 2 ; P <0.001; right ventricular mass/body surface area, 36±7 and 24±5 g/m 2 ; P <0.001) and indexed left ventricular end-diastolic volume and right ventricular end-diastolic volume (left ventricular end-diastolic volume/body surface area, 104±13 and 69±18 mL/m 2 ; P <0.001; right ventricular end-diastolic volume/body surface area, 110±22 and 66±16 mL/m 2 ; P <0.001) were significantly increased in athletes in comparison with control subjects. Right ventricular ejection fraction did not differ between athletes and control subjects (52±8 and 54±6%; P =0.26). Pathological late enhancement was detected in 1 athlete. No correlations were found for left ventricular and right ventricular volumes and ejection fraction with N-terminal pro-brain natriuretic peptide, and high-sensitive troponin was negative in all subjects. Conclusions— Based on our results, chronic right ventricular damage in elite endurance master athletes with lifelong high training volumes seems to be unlikely. Thus, the hypothesis of an exercise-induced arrhythmogenic right ventricular cardiomyopathy has to be questioned.

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“…From June 2008 to March 2009, 210 healthy, normally active, non-athletic subjects and 650 top-level athletes were prospectively recruited and successively studied by 2D echocardiography at Monaldi Hospital, Naples, Italy, as previously described [15]. The athletes of this study were employed by professional sports organisations and had been exercising intensively for 15-20 h/week for >4 years.…”

Section: Methodsmentioning

confidence: 99%

“…The athletes of this study were employed by professional sports organisations and had been exercising intensively for 15-20 h/week for >4 years. The athletes were referred for cardiovascular examination before participation in a sports competition [15]. Volunteer controls were selected from the department of Cardiology in Naples, Italy, and investigated for work eligibility.…”

Section: Methodsmentioning

confidence: 99%

“…None of the control subjects suffered from cardiovascular structural or functional abnormalities or were receiving any medication in this regard. The subjects' screening contained a physical examination, a detailed history, electrocardiography, chest radiography, an exercise test, measuring of BSA and a comprehensive transthoracic echocardiography, including Doppler echocardiography, as described previously [8,15]. Subjects suffering from cardiopulmonary diseases such as coronary artery disease, systemic arterial hypertension, valvular or congenital heart disease, bicuspid aortic valve, congestive heart failure, cardiomyopathies and diabetes mellitus were rejected from the study.…”

Section: Methodsmentioning

confidence: 99%

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Reference Ranges for and Determinants of Right Ventricular Area in Healthy Adults by Two-Dimensional Echocardiography

et al. 2015

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Background: The right ventricular (RV) area is important for diagnosis and follow-up in patients with various diseases, such as in pulmonary hypertension. Objectives: The aim of this study was to define the reference ranges of the end-diastolic RV area in healthy adults and to assess the determining factors. Methods: In the first part of the study 860 healthy subjects (37.6% female; mean age 28 ± 5.84; 395 endurance athletes, 255 strength athletes and 210 non-athletes) were prospectively assessed. In the second part we performed a pooled analysis of studies published between 1979 and 2014 describing the RV area in healthy subjects (n = 5,248).Statistical analysis included the calculation of reference ranges and the analysis of determining factors. Results: Mean end-diastolic RV areas in 860 healthy subjects were significantly larger in endurance athletes (25.1 ± 2.0 cm²) compared with strength athletes (22.9 ± 1.7 cm²) and non-athletes (16.7 ± 2.0 cm², p < 0.001). In the synopsis of both data sets, mean end-diastolic RV area was significantly larger in European/American males (17 cm²) compared with females (14 cm², p < 0.001) and in Asian males (16 cm²) compared with females (13 cm², p < 0.001). The area increased with body surface area and older age. Conclusion: This is the largest data set to define RV size in healthy adults aged <50 years. RV area was determined by age, gender, body surface area, ethnicity and high-level exercise training. High standard deviations resulted in high values for the upper limit of the reference range, which might therefore not be useful as cut-off values for screening purposes. Gender- and ethnicity-specific reference ranges should be used. Further studies in subjects aged >50 years as well as in children are needed.

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Range of right heart measurements in top-level athletes: The training impact

Cited by 145 publications

References 43 publications

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

Right and Left Ventricular Function and Mass in Male Elite Master Athletes

Reference Ranges for and Determinants of Right Ventricular Area in Healthy Adults by Two-Dimensional Echocardiography

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