Natural history of right ventricle: longitudinal study in veteran athletes

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Right ventricular (RV) enlargement is a physiologic adaptation to long lasting athletic training. Its clinical implications for veteran athletes are poorly understood. In recent years, controversial data suggest an association between ultra-endurance exercise and a RV cardiomyopathy similar to arrhythmogenic cardiomyopathy (ACM). In this context, the effects of exercise detraining have not been extensively studied yet. PURPOSE The aim of this study was to assess the morphological and functional RV changes in veteran athletes and to evaluate the effect of a long period of detraining. METHODS This is a longitudinal study including 22 veteran rowers with at least 10 years of competitive career. We evaluated them with an echocardiographic assessment at baseline and after a minimum of 3 years of detraining (age: 23.2 ± 4.4 and 43 ± 7.4 years), by reducing the weekly training volume from 26 ± 0.7 to 3 ± 2 hours. In this second evaluation we also performed an RV strain analysis and a cardiac magnetic resonance (CMR) study. RESULTS RV end diastolic (ED) areas significantly reduced after detraining (31.48 ± 5.8 versus 28.59 ± 6.8; p = 0.001), although remaining larger than normal. RV enlargement was balanced: the ratio between inflow (IT) and outflow tract (OT) (RVIT/RVOT = 1.4 ± 0.1) and the ratio between RV and left ventricle (LV) (RV/LV = 0.81 ± 0.1) were within normal limits. The fractional area change (FAC%) was normal at baseline and increased significantly (41.5 ± 6% versus 45.8 ± 7%; p = 0.011). After detraining, RV longitudinal strain was normal (-19.7 ± 2.7%). CMR assessment showed enlarged RVED volumes (97.9 ± 14 ml/m2) but normal RV ejection fraction (55.5 ± 4.1%). CONCLUSIONS RV enlargement in endurance athletes persists after a long period of detraining. However, detraining results in a significant reduction of RV dimensions. Furthermore, the absence of RV dysfunction or disproportionate RV geometry are reassuring findings that suggest a physiological remodeling of the RV. Significant echo findings. RV ECHO PARAMETERS BASELINE DETRAINING MEAN DIFF. (C.I. 95%) p VALUE RVOT plax (mm) 34.8 ± 4 33.7 ± 14 1.1 (0.18; 2.1) p = 0.011 RVOT psax (mm) 34.9 ± 3.3 33.09 ± 3.5 1.8 (0.9; 2.7) p < 0.001 RV basal diameter (mm) 47.31 ± 5.3 45.86 ± 6.4 1.4 (0.04; 2.8) p = 0.022 RV end-diastolic area (cm²) 31.48 ± 5.8 28.59 ± 6.8 2.8 (1.1; 4.6) p = 0.001 FAC% 41.5 ± 6 45.8 ± 7 0.04 (-0.07; -0.007) p = 0.011 RV inflow/outflow ratio 1.36 ± 0.1 1.36 ± 0.2 -0.003 (-0.06; 0.06) p = 0.454 RV/LV ratio 0.82 ± 0.07 0.81 ±0.1 0.01 (-0.01; 0.04) p = 0.219 Abstract Figure. Comparison in the same veteran athlete.