Biventricular mechanical pattern of the athlete’s heart: comprehensive characterization using three-dimensional echocardiography

Author:

Fábián Alexandra1ORCID,Ujvári Adrienn1,Tokodi Márton1ORCID,Lakatos Bálint Károly1ORCID,Kiss Orsolya12,Babity Máté1,Zámodics Márk1,Sydó Nóra12ORCID,Csulak Emese1ORCID,Vágó Hajnalka12,Szabó Liliána1,Kiss Anna Réka1,Szűcs Andrea1,Hizoh Istvan1,Merkely Béla12,Kovács Attila1ORCID

Affiliation:

1. Heart and Vascular Center, Semmelweis University , Városmajor str. 68, Budapest H-1122 , Hungary

2. Department of Sports Medicine, Semmelweis University , Budapest , Hungary

Abstract

Abstract Aims While left ventricular (LV) adaptation to regular, intense exercise has been thoroughly studied, data concerning the right ventricular (RV) mechanical changes and their continuum with athletic performance are scarce. The aim of this study was to characterize biventricular morphology and function and their relation to sex, age, and sports classes in a large cohort of elite athletes using three-dimensional (3D) echocardiography. Methods and results Elite, competitive athletes (n = 422) and healthy, sedentary volunteers (n = 55) were enrolled. Left ventricular and RV end-diastolic volumes (EDVi) and ejection fractions (EFs) were measured. To characterize biventricular mechanics, LV and RV global longitudinal (GLS) and circumferential strains (GCS) were quantified. All subjects underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg). Athletes had significantly higher LV and RV EDVi compared with controls (athletes vs. controls; LV EDVi: 81 ± 13 vs. 62 ± 11 mL/m2, RV EDVi: 82 ± 14 vs. 63 ± 11 mL/m2; P < 0.001). Concerning biventricular systolic function, athletes had significantly lower resting LV and RV EF (LV EF: 57 ± 4 vs. 61 ± 5%; RV EF: 55 ± 5 vs. 59 ± 5%; P < 0.001). The exercise-induced relative decrease in LV GLS (9.5 ± 10.7%) and LV GCS (10.7 ± 9.8%) was similar; however, the decrement in RV GCS (14.8 ± 17.8%) was disproportionately larger compared with RV GLS (1.7 ± 15.4%, P < 0.01). Right ventricular EDVi was found to be the strongest independent predictor of VO2/kg by multivariable linear regression. Conclusion Resting LV mechanics of the athlete’s heart is characterized by a balanced decrement in GLS and GCS; however, RV GCS decreases disproportionately compared with RV GLS. Moreover, this mechanical pattern is associated with better exercise capacity.

Funder

National Research, Development and Innovation Fund of Hungary

Thematic Excellence Program

Tématerületi Kiválósági Program

Ministry for Innovation and Technology in Hungary

Therapeutic Development and Bioimaging programmes of the Semmelweis University

National Research, Development and Innovation Fund

New National Excellence Program of the Ministry for Innovation and Technology

National Research, Development, and Innovation Fund

National Research, Development and Innovation Office (NKFIH) of Hungary

János Bolyai Research Scholarship of the Hungarian Academy of Sciences

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Epidemiology

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