19 Aug Right Ventricular Changes in Olympic Athletes Described
MedicalResearch.com Interview with:
Antonio Pelliccia, MD, FESC
Chief of Cardiology
Institute of Sport Medicine and Science
MedicalResearch.com: What is the background for this study?
Response: The awareness of the relevant role of arrhythmogenic right ventricular cardiomyopathy (ARVC) as cause of athletic field events and the refined Task Force (TF) criteria for the diagnosis of the disease have prompted a large scientific interest and triggered a vast scientific literature on this issue.
Indeed, the recent observations by Heidbuchel and La Gerche based on data from a selected group of ultra-endurance athletes, suggesting that strenuous, chronic endurance exercise may ultimately cause, per se, RV dysfunction have further stimulated the need to define the characteristics and limits of training-induced RV remodelling.
At present, however, no studies have assessed the characteristic of physiologic right ventricular remodelling as derived from a large population of highly-trained athletes, including a sizeable number of women and comprising a broad spectrum of summer and winter Olympic sport disciplines.
MedicalResearch.com: What is the study population? What are the main findings?
Response: In the present study, we assessed the characteristics of right ventricular remodelling and the determinants (i.e., the impact of gender and type of sport) in a large cohort (> 1,000) of highly trained, elite athletes.
We found that right ventricular dimensions are larger in athletes compared to that reported in normal, untrained individuals. The absolute values of RV cavity are larger in male compared to females (by 6% to 8%), but differences disappear or reverse when values are normalized to body size.
Moreover, qualitative assessment of the RV chamber showed that the both the RV inflow area and the RV outflow tracts are symmetrically altered. Indeed, a subset of athletes presented a rounded shaped apex, or prominent RV trabecular pattern, similar that that observed in patients with ARVC. However, despite dimensional increase in RV chamber and shape peculiarities, the major difference was that no RV wall-motion abnormalities were observed in trained athletes, substantiating the absence of pathologic substrate.
Another relevant observation is that the extent of RV remodelling is proportional (and related) to the LV remodelling (as suggested by the linear relationship between the increase in RV and LV chambers areas).
Statistical analysis showed that male gender and endurance disciplines (such as cycling, rowing, swimming, cross-country skiing) were associated with the greatest impact on RV remodelling, suggesting their role as main determinants for the RV remodelling in highly trained athletes
MedicalResearch.com: What should readers take away from your report?
Response: The upper limits of right ventricular dimensions derived by the present cohort of highly trained athletes were compared with the widely used Task Force major and minor criteria to diagnose ARVC. We observed that a significant subset of normal athletes (up to 32%) exceeds the reference dimensional limits of the right ventricular outflow tract (either absolute and normalized to body surface area), as advised by the Task Force and even more by the ASE for diagnosis of ARVC in the general population.
According to our findings, we therefore recommend not applying the conventional ASE criteria of RV enlargement when evaluating the RV in highly trained athletes, but refer only to the major criteria normalized to BSA as advised by the Task Force. These limits are consistent to the 95° percentile dimensional values we observed in our large cohort of top-level athletes, respectively 18 mm/m2 for RV outflow tract (parasternal axis) and 20 mm/m2 for RV outflow tract (short axis). Indeed, any marked disproportional change in the right ventricular inflow vs. outflow tract as well as the presence of RV wall motion abnormality is inconsistent with a purely physiologic RV remodelling.
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