European Heart Journal Advance Access originally published online on November 3, 2007
European Heart Journal 2007 28(24):3094; doi:10.1093/eurheartj/ehm438
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The right ventricle: two roles for one actor
Department of Sports Medicine Istanbul Faculty of Medicine Istanbul University Istanbul 34840 Turkey Tel: +90 216 340 5316 fax: +90 216 340 5316 E-mail address: ekasikcioglu{at}yahoo.com
With great interest I read the article ‘Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment’ by Ector et al.1 Even if invasive methods are employed, a thorough evaluation of the morphology and functions of the right ventricle (RV) may be difficult due to the complex geometry and anatomy. Examination of RV geometry in athletes poses an additional puzzle because of the gross changes of both ventricular shape and function associated with athletic training.2 Based on the current literature, the RV plays two major roles in cardiovascular function and prognosis: both good and bad.
In its deleterious role, dysfunction and pathologies of the RV lead to series cardiac arrhythmias and a poor prognosis.3 Studies have shown that the patient's degree of ventricular geometric distortion correlates with RV or left ventricle (LV) pressure and volume overload, which often affects each other.4 It has also been shown that primary RV systolic dysfunction can lead to secondary changes in the systolic and diastolic function of the LV. 4 Although the authors of this study presented ventricular arrhythmias and RV dysfunction, the authors did not test the effects of LV functions on RV functions by multivariate analysis. RV changes without evaluating any real time LV alterations this may lead to difficulties. Biffi et al.5 found that a reduction in the frequency of ventricular tachyarrhythmias after deconditioning and the absence of cardiac events in follow-up support the benign clinical nature of these rhythm disturbances as just another expression of athlete's heart. But an important question that has not been asked is what prognostic role could ventricular arrhythmias play in athletes without cardiovascular abnormalities?
In its beneficial role, a better functional RV in the maintenance of endurance capacity and its function may contribute to enhanced endurance capacity via increased LV filling and performance.6 Both the pulmonary and the systemic circulation must show a performance change to meet a circulatory demand of extensive and prolonged physical exercise.6 Both the RV and the LV must alter its performance to meet the increased circulatory demands of exercise. RV adaptation to intense and prolonged physical exercise may be expected to increase the RV cavity dimensions, with a concomitant increase in RV contractile reserve.6,7 Interestingly, RV cavity diameters in endurance-training athletes were higher than in strength – this phrase/sentence also needs a numerical reference training athletes. It is proposed that volume overload exercise training (isotonic type) causes a greater increase in the diameter of the RV cavity compared with volume overload exercise training (isometric type).7 Furthermore, D'Andrea et al.8 recently reported that there was a close association between LV end-diastolic diameter and peak early diastolic velocity of RV in the overall master athletes. In addition, early-diastolic right ventricular myocardial function was a powerful independent determinant of both LV stroke volume and of maximal workload achieved during physical effort.
In conclusion, although it is known that alterations of RV functions affect both the global functioning and prognosis, several important questions remain for athletes who have suspicious right ventricular dysfunction, including how should the prognosis be evaluated and what are the recommendations available?
References
- Ector J, Ganame J, van der Merwe N, Adriaenssens B, Pison L, Willems R, Gewillig M, Heidbuchel H. Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment. Eur Heart J (2007) 28:345–353.
[Abstract/Free Full Text] - Kasikcioglu E. A difficult puzzle: Right ventricular remodeling in athletes. Int J Cardiol (2005) 103:114.[CrossRef][Web of Science][Medline]
- Juilliere Y, Barbier G, Feldmann L, Grentzinger A, Danchin N, Cherrier F. Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy. Eur Heart J (1997) 18:276–280.
[Abstract/Free Full Text] - Dittrich HC, Chow LC, Nicod PH. Early improvement in left ventricular diastolic function after relief of chronic right ventricular pressure overload. Circulation (1989) 80:823–830.
[Abstract/Free Full Text] - Biffi A, Maron BJ, Verdile L, Fernando F, Spataro A, Marcello G, Ciardo R, Ammirati F, Colivicchi F, Pelliccia A. Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol (2004) 44:1053–1058.
[Abstract/Free Full Text] - Henricksen E, Landelius J, Kangro T, Jonason T, Hedberg P, Wesslen L, Rosander CN, Rolf C, Ringqvist I, Friman G. An echocardiographic study of right and left ventricular adaptation to physical exercise in elite female orienteers. Eur Heart J (1999) 20:309–316.
[Abstract/Free Full Text] - Kasikcioglu E, Oflaz H, Akhan H, Kayserilioglu A. Right ventricular myocardial performance index and exercise capacity in athletes. Heart Vessels (2005) 20:147–152.[CrossRef][Web of Science][Medline]
- D'Andrea A, Caso P, Scarafile R, Salerno G, De Corato G, Mita C, Di Salvo G, Allocca F, Colonna D, Caprile M, Ascione L, Cuomo S, Calabro R. Biventricular myocardial adaptation to different training protocols in competitive master athletes. Int J Cardiol (2007) 115:342–349.[CrossRef][Web of Science][Medline]
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