title: Range of right heart measurements in top-level athletes: the training impact.
abstract: OBJECTIVE
  To explore the full range of right heart dimensions and the impact of long-term intensive training in athletes.
  
  
  BACKGROUND
  Although echocardiography has been widely used to distinguish the athlete's heart from pathologic left ventricular (LV) hypertrophy, only few reports have described right ventricular (RV) and right atrial (RA) adaptations to extensive physical exercise.
  
  
  METHODS
  650 top-level athletes [395 endurance- (ATE) and 255 strength-trained (ATS); 410 males (63.1%); mean age 28.4 ± 10.1; 18-40 years] and 230 healthy age- and sex-comparable controls underwent a transthoracic echocardiographic exam. Along with left heart parameters, right heart measurements included: RV end-diastolic diameters at the basal and mid-cavity level; RV base-to-apex length; RV proximal and distal outflow tract diameters; RA long and short diameters; and RA area. Tricuspid annular plane systolic excursion and RV tissue Doppler systolic peak velocity were assessed as indexes of RV systolic function. Pulmonary artery systolic pressure (PASP) was estimated from the peak tricuspid regurgitant velocity.
  
  
  RESULTS
  ATS showed increased sum of wall thickness and relative wall thickness, whereas left atrial volume, LV end-diastolic volume, LV stroke volume and PASP were significantly higher in ATE. RV and RA measurements were all significantly greater in ATE than in ATS and controls. ATE also showed improved early diastolic RV function, whereas RV systolic indexes were comparable among groups. On multivariate analysis, type and duration of training (p<0.01), PASP (p<0.01) and LV stroke volume (p<0.001) were the only independent predictors of the main RV and RA dimensions in athletes.
  
  
  CONCLUSIONS
  This study delineates the upper limits of RV and RA dimensions in highly-trained athletes. Right heart measurements were all significantly greater in elite endurance-trained athletes than in age- and sex-matched strength athletes and controls. This should be considered as a "physiologic phenomenon" when evaluating athletes for sports eligibility.
authors: Second University of Naples, Italy. antonellodandrea@libero.it
authors: Antonello
authors: A
authors: D'Andrea
authors: Lucia
authors: L
authors: Riegler
authors: Enrica
authors: E
authors: Golia
authors: Rosangela
authors: R
authors: Cocchia
authors: Raffaella
authors: R
authors: Scarafile
authors: Gemma
authors: G
authors: Salerno
authors: Enrica
authors: E
authors: Pezzullo
authors: Luigi
authors: L
authors: Nunziata
authors: Rodolfo
authors: R
authors: Citro
authors: Sergio
authors: S
authors: Cuomo
authors: Pio
authors: P
authors: Caso
authors: Giovanni
authors: G
authors: Di Salvo
authors: Antonio
authors: A
authors: Cittadini
authors: Maria Giovanna
authors: MG
authors: Russo
authors: Raffaele
authors: R
authors: Calabrò
authors: Eduardo
authors: E
authors: Bossone
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D056352:Athletes; D004452:Echocardiography; D015444:Exercise / Q000502:physiology; D005260:Female; D006321:Heart / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D010807:Physical Endurance / Q000502:physiology; D013177:Sports / Q000502:physiology; D013997:Time Factors; D055815:Young Adult