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The right ventricle of olympic athletes: characteristics and implications for the clinical evaluation

Session Young Investigator Award session - Clinical Science - The Roelandt's Young Investigator Award

Speaker Assistant Professor Flavio D'Ascenzi

Event : EuroEcho 2016

  • Topic : preventive cardiology
  • Sub-topic : Athlete´s Heart
  • Session type : Abstract Session

Authors : F D'ascenzi (Siena,IT), A Pisicchio (Rome,IT), S Caselli (Rome,IT), FM Di Paolo (Rome,IT), A Spataro (Rome,IT), A Pelliccia (Rome,IT)

F D'ascenzi1 , A Pisicchio2 , S Caselli2 , FM Di Paolo2 , A Spataro2 , A Pelliccia2 , 1University of Siena, Department of Medical Biotechnologies, Division of Cardiology - Siena - Italy , 2Institute of Sport Medicine and Science CONI - Rome - Italy ,

European Heart Journal Supplements ( 2016 ) 17 ( Supplement 2 ), ii70

Background. Clinical uncertainty exists regarding the normal values and the ultimate clinical significance of right ventricular (RV) morphologic changes observed in highly trained athletes. We therefore planned the present study: to assess the impact of gender and different type of sports on RV remodeling and to describe the normal values of the RV and right atrial dimension and function also compared to clinically used cut-off values. 

Methods. 1009 Olympic athletes (mean age 24±6 years, 647/64% males) were evaluated. All denied cardiac symptoms and reported negative family history for cardiomyopathies or sudden death. Athletes were divided into 4 subgroups in relation to the predominant characteristics of training: skill, power, mixed, and endurance disciplines. 

Results. Absolute RV dimensions were larger in males. Endurance athletes had the greatest RV dimensions compared to the remaining athletes (p<0.001). RVOT increased from skill, power, mixed to endurance sports (25.8±3.5 vs. 27.4±3.8 vs. 28.1±3.6 vs. 29.2±3.8 mm, respectively, p<0.001) such as RV basal EDD (36.4±5.6 vs. 38.5±5.7 vs. 39.4±5.1 vs. 40.4±5.3, p<0.001) and RV diastolic area (21.2±5.3 vs. 22.6±5.2 vs. 23.7±4.6 vs. 24.7±5.2 mm, p<0.001). A similar trend was observed for RA area (15.6±3.7 vs. 17.1±3.9 vs. 18.1±3.7 vs. 19.0±4.0 cm2, p<0.001). Both FAC and TDI-s’ did not differ among the groups (p=0.34 for both). When RV dimensions in Olympic athletes were compared to previously reported cut-off values, 231 (23%) had RVOT in long axis exceeding the American Society of Echocardiography (ASE) criteria, while 160 (16%) and 410 (41%) fulfilled respectively the major and minor criteria for the diagnosis of arrhythmogenic RV cardiomyopathy (ARVC). Similarly 61 (6%) had RVOT in short axis exceeding the ASE criteria, while 61 (6%) and 299 (30%) fulfilled the major and minor criteria for the diagnosis of ARVC. In terms of qualitative assessment, a rounded apex was described in 823 (81%) and prominent trabeculations in 378 (37%) athletes; a prominent or hyper-reflective moderator band was found in 5 athletes (0.5%). 

Conclusions. Physiologic RV remodeling is common in Olympic athletes, with males and endurance athletes showing the greater extent of absolute RV enlargement, frequently associated with rounded apex and prominent trabeculations. A substantial minority (up to 16%) even exceeded the dimensional changes consistent with Task Force major criteria for diagnosis of ARVC, in the absence of global or segmental RV wall motion abnormalities

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