Enlargement of the Right Heart in the Endurance Athlete: A Two-Dimensional Echocardiographic Study

M-mode echocardiographic studies of endurance-trained athletes have provided conflicting data for right ventricular (RV) dimensions and no data for right atrial (RA) size. Since two-dimensional echocardiography provides a more accurate measurement of the RV and RA, it was employed together with M-mode echocardiography to evaluate 12 male endurance athletes and 12 sedentary controls matched for body size and age. All subjects were screened by history, physical examination, ECG, and maximal exercise testing. RV and RA areas were planimetered in the apical four-chamber view while displaying maximal chamber sizes. Athletes had significantly greater left ventricular (LV) wall thickness (P less than 0.01), LV area (P less than 0.001), and left atrial (LA) area (P less than 0.01). They also had greater RV area (P less than 0.01), RV wall thickness (P less than or equal to 0.05), and RA area (P less than or equal to 0.01). Maintained proportionality of the cardiac chamber dimensions in the athletes was shown by similar ratios of right-to-left ventricular areas, right-to-left atrial areas, and right-to-left ventricular wall thicknesses in both groups. The symmetry of the greater athlete's heart differs from most pathological conditions which have heterogeneous effects on specific cardiac chambers.