Range in pulmonary artery systolic pressure among highly trained athletes.
BACKGROUND
Although the physiologic range of pulmonary artery systolic pressure (PASP) has been reported, data on how it is manifested in athletes are limited. The aim of the present study was to explore the full spectrum of PASP and the long-term training impact in a large population of highly trained athletes.


METHODS
Six hundred fifteen consecutive athletes (370 endurance-trained athletes [ATEs] vs 245 strength-trained athletes [ATSs]; 28.4 ± 10.1 years old) and 230 healthy control subjects (27.5 ± 11.3 years old) underwent transthoracic echocardiography. PASP was estimated by measuring maximal tricuspid regurgitant jet velocity (TRV) with the modified Bernoulli equation. The ratio of TRV to right ventricular outflow tract time-velocity integral (TRV/RVOTTVI) was obtained as a correlate of pulmonary vascular resistance (PVR).


RESULTS
Left ventricular (LV) mass index and ejection fraction did not differ significantly between the two groups of athletes. Conversely, ATSs showed an increased sum of wall thickness and relative wall thickness, whereas LV end-diastolic diameter, LV stroke volume, peak TRV, and PASP were significantly higher in ATEs. The ratio between transmitral E wave and tissue Doppler e' wave was not different among the three groups. The ratio TRV/RVOTTVI was ≤ 0.2 (ie, normal PVR) in all subjects. A TRV value > 2.5 m/s was observed in 76 athletes (12.3%). By multivariable analysis, age (P < .01), type and duration of training (P < .01), and LV stroke volume (P < .001) were the only independent predictors of PASP in athletes.


CONCLUSIONS
This study delineates the full range of resting TRV and derived PASP in highly trained athletes. The upper physiologic limit of PASP in endurance athletes may reach 40 mm Hg, in line with the greater increase in stroke volume. This should be considered a "physiologic phenomenon" when evaluating athletes for sports eligibility.
D'Andrea
Antonello
A
Department of Cardiology, Second University Naples, Naples, Italy.
Naeije
Robert
R
Department of Pathophysiology, Erasme University Hospital, Erasme Campus, Brussels, Belgium.
D'Alto
Michele
M
Department of Cardiology, Second University Naples, Naples, Italy.
Argiento
Paola
P
Department of Cardiology, Second University Naples, Naples, Italy.
Golia
Enrica
E
Department of Cardiology, Second University Naples, Naples, Italy.
Cocchia
Rosangela
R
Department of Cardiology, Second University Naples, Naples, Italy.
Riegler
Lucia
L
Department of Cardiology, Second University Naples, Naples, Italy.
Scarafile
Raffaella
R
Department of Cardiology, Second University Naples, Naples, Italy.
Limongelli
Giuseppe
G
Department of Cardiology, Second University Naples, Naples, Italy.
Di Salvo
Giovanni
G
Department of Cardiology, Second University Naples, Naples, Italy.
Citro
Rodolfo
R
Department of Cardiology University of Salerno, Salerno, Italy.
Caso
Pio
P
Department of Cardiology, Second University Naples, Naples, Italy.
Russo
Maria Giovanna
MG
Department of Cardiology, Second University Naples, Naples, Italy.
Calabrò
Raffaele
R
Department of Cardiology, Second University Naples, Naples, Italy.
Bossone
Eduardo
E
Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy. Electronic address: ebossone@hotmail.com.
D000328:Adult; D056352:Athletes; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012016:Reference Values; D012189:Retrospective Studies; D013599:Systole; D018615:Ultrasonography, Doppler, Color