title: Reduced right ventricular myocardial strain in the elite athlete may not be a consequence of myocardial damage. "Cream masquerades as skimmed milk".
abstract: BACKGROUND
  Latest research shows that the lower resting values of right ventricular (RV) myocardial % strain may represent a physiologic change rather than subclinical myocardial damage. Therefore, we assessed load-independent changes to the RV as a consequence of high intensity training by measuring the Isovolumic acceleration (IVA) of the free wall of the RV in conjunction with NT pro-BNP measured by an electrochemiluminescence assay.
  
  
  METHODS
  Seventeen controls (mean age 27 ± 4), 24 soccer footballers (mean age 24 ± 4), and 18 elite rowers (mean age 22 ± 4) were studied. Left ventricular (LV) and RV % strain were measured using two-dimensional (2D) speckle based automated functional imaging (AFI) software. RV free wall IVA was measured using pulsed-wave tissue Doppler at the lateral tricuspid annulus. Standard 2D echo were used to measured RV parameters including the Tei index (systolic and diastolic function) and the total annular plane systolic excursion (TAPSE) of the RV annulus. NT pro-BNP was measured by an electrochemiluminescence assay.
  
  
  RESULTS
  The RV diameter was increased in the footballers and elite rowers compared with controls (P < 0.001). RV wall size was greater in the elite rowers compared with controls and footballers (P = 0.002). The peak IVA of the RV was higher in the rowers, compared with the footballers and to controls (P < 0.001). The mean LV and RV % myocardial strain were lower in the elite athletes and the footballers compared with controls (P < 0.001). There was no difference in RV Tei index, levels of BNP, and TAPSE across all subjects.
  
  
  CONCLUSIONS
  This study showed a significant increase in IVA of the RV of athletes despite reduced myocardial % strain and normal levels in NT-proBNP. This suggests that the decrease in % strain is not a consequence of myocardial damage, but may represents a part of the physiological response to endurance exercise. Therefore, a reduced IVA in a remodeled RV could herald a pathological response.
authors.affiliation: Eagle Lodge Medical Centre, Limerick, Ireland; Department of Cardiology (CREST), St. James's Hospital, Dublin, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: King
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Almuntaser
authors.forename: Ross T
authors.initials: RT
authors.lastname: Murphy
authors.forename: Andre
authors.initials: A
authors.lastname: La Gerche
authors.forename: Nick
authors.initials: N
authors.lastname: Mahoney
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennet
authors.forename: John
authors.initials: J
authors.lastname: Clarke
authors.forename: Angela
authors.initials: A
authors.lastname: Brown
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010807:Physical Endurance; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013177:Sports; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult
keywords: athlete; isovolumic acceleration; right ventricle; strain; sub-clinical dysfunction