European Heart Journal Advance Access originally published online on February 24, 2009
European Heart Journal 2009 30(8):969-977; doi:10.1093/eurheartj/ehp040
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Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes
1 Department of Cardiology, HP F.02.352, University Medical Centre Utrecht, Heidelberglaan100, 3582 CX Utrecht, The Netherlands
2 Department of Radiology, University Medical Centre Utrecht, The Netherlands
3 Centre for Biostatistics, University Medical Centre Utrecht, The Netherlands
Received 4 August 2008; revised 22 December 2008; accepted 15 January 2009; online publish-ahead-of-print 24 February 2009.
* Corresponding author. Tel: +31 887553374, Fax: +31 887555479, Email: a.j.teske{at}gmail.com
Aims: To investigate the physiological adaptation of the right ventricle (RV) in response to endurance training and to define reference values for regional deformation in the RV in endurance athletes.
Methods and results: Healthy controls (n = 61), athletes (n = 58), and elite athletes (n = 63) were prospectively enrolled with a training intensity of 2.2 ± 1.6, 12.5 ± 2.3 and 24.2 ± 5.7 h/week, respectively (P < 0.001). Conventional echocardiographic parameters, tissue Doppler imaging (TDI), and 2D strain echo (2DSE)-derived velocity, strain, and strain rate (SR) were calculated in three RV segments. Left ventricular and RV dimensions were significantly increased (P < 0.001) in both groups of athletes compared with controls. Right ventricular systolic velocities and displacement were not different between the groups. Right ventricular strain and SR values were reduced in the RV basal and mid-segment in athletes. Athletes with marked RV dilatation showed lower strain and SR values in the basal (–20.9 ± 4.7 vs. –24.5 ± 4.9%, P < 0.001 and –1.23 ± 0.31 vs. –1.50 ± 0.33 s–1, P < 0.001) and mid (–29.3 ± 5.4 vs. –32.1 ± 5.3%, P = 0.017 and –1.58 ± 0.41 vs. –1.82 ± 0.42 s–1, P = 0.009) segment, whereas athletes without RV dilatation showed no significant difference compared with the controls.
Conclusion: Regional deformation and deformation rates (TDI and 2DSE) are reduced in the basal RV segment in athletes. This phenomenon is most pronounced in athletes with RV dilatation and should be interpreted as normal when evaluating athletes suspected for RV pathology.
Key Words: Echocardiography • Right ventricle • Athletes • Tissue Doppler