Abstract 6916: The Right Ventricle in Adolescent Athletes: Standing up for the Smaller Side

Abstract

Introduction: Athletic training often results in changes that may mimic features of pathological cardiomyopathies. These changes are influenced by age, ethnicity and sporting discipline. Studies detailing the physiological adaptation to exercise on the right ventricle (RV) of adolescent athletes are fewer compared to the left ventricle, with even fewer describing the impact of ethnicity on the RV. One such potential physiological overlap with pathological change is arrhythmogenic right ventricular dysplasia (ARVD). An erroneous interpretation may have profound consequences ranging from false reassurance in a vulnerable athlete to unfair disqualification in a healthy individual. Therefore, it is important for the clinician to distinguish physiology from pathology. Results: ECG and echocardiographic data of 3000 academy male footballers were analysed, aged between 13 and 18 years old (mean age 16.4 ± 0.5 years), who underwent mandatory cardiac screening. Ethnicity was categorised as white (n=1000), black (n=1000) and mixed-race (n=1000). Overlap between ECG changes expected in ARVD and the adolescent athlete was observed. ARVD major criteria for TWI was seen in (n=63) 6.3% of the cohort. This was more prevalent in black footballers (n= 37; 3.7%) when compared to mixed race footballers (n=20; 2%) or white footballers (n=6; 0.6%), p<0.05. In up to 67% of the overall cohort, RV values exceeded those for normal adult reference ranges. Overall, 0.2% of the cohort would fulfil diagnosis for ‘definite’ ARVD and 2.2% would fulfil diagnosis for ‘borderline’ ARVD. This was seen more frequently in black footballers (n=99, 9.9%) than mixed race footballers (n=39, 3.9%) or white footballer (n=6; 0.6%), P = 0.0005. Among athletes meeting definite or borderline ARVD criteria, no cardiomyopathy was identified. Conclusion: This is the largest study to our knowledge that reports RV dimension data among adolescent footballers of different ethnicities. Right heart sizes in excess of standard adult ranges occurred in as many as one in 5 athletes. It is not unusual to observe values that would overlap with criteria for ARVD. As with LV parameters, variations in terms of ethnicity should be accounted for when performing routine cardiac assessments of adolescent athletes.