Does athletic training in high-dynamic sports alter right ventricular pressure and function compared to controls?
Functional right ventricular adaptation, including increased tricuspid annular displacement, a greater base-to-apex strain gradient, and slightly elevated RV systolic pressure, is a normal feature of the athlete's heart.
Background: Structural remodeling of the right ventricle (RV) is widely documented in athletes. However, functional adaptation, including RV pressure generation and systolic free-wall longitudinal mechanics, remains equivocal. This meta-analysis compared RV pressure and function in athletes and controls. Methods: A systematic review of online databases was conducted up to June 4, 2020. Meta-analyses were performed on RV systolic pressures, at rest and during exercise, tricuspid annular plane systolic displacement, myocardial velocity (S’), and global and regional longitudinal strain. Bias was assessed using Egger regression for asymmetry. Data were analyzed using random-effects models with weighted mean difference and 95% CI. Results: Fifty-three studies were eligible for inclusion. RV systolic pressure was obtained from 21 studies at rest ( n =1043:1651; controls:athletes) and 8 studies during exercise ( n =240:495) and was significantly greater in athletes at rest (weighted mean difference, 2.9 mmHg CI, 1.3–4.5 mmHg; P =0.0005) and during exercise (11.0 6.5–15.6 mm Hg; P <0.0001) versus controls. Resting tricuspid annular plane systolic displacement ( P <0.0001) and S’ ( P =0.001) were greater in athletes. In contrast, athletes had similar RV free-wall longitudinal strain (17 studies; n =450:605), compared with controls but showed greater longitudinal apical strain (16 studies; n =455:669; 0.9%, 0.1%–1.8%; P =0.03) and lower basal strain (−2.5% −1.4 to −3.5%; P <0.0001). Conclusions: Functional RV adaptation, characterized by increased tricuspid annular displacement and velocity and a greater base-to-apex strain gradient, is a normal feature of the athlete’s heart, together with a slightly elevated RV systolic pressure. These findings contribute to our understanding of RV in athletes and highlight the importance of considering RV function in combination with structure in the clinical interpretation of the athlete’s heart.
Dawkins et al. (Sat,) studied this question.
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