title: Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin.
abstract: BACKGROUND
  Regular, intensive exercise results in physiological biventricular cardiac adaptation. Ethnicity is an established determinant of left ventricular remodeling; black athletes (BAs) exhibit more profound LV hypertrophy than white athletes (WAs). Right ventricular (RV) remodeling has not been characterized in BAs, although the issue is pertinent because BAs commonly exhibit ECG anomalies that resemble arrhythmogenic RV cardiomyopathy.
  
  
  RESULTS
  Between 2006 and 2012, 300 consecutive BAs (n=243 males) from 25 sporting disciplines were evaluated by use of ECG and echocardiography. Results were compared with 375 WAs and 153 sedentary control subjects (n=69 blacks). There were no ethnic differences between RV parameters in control subjects. Both BAs and WAs exhibited greater RV dimensions than control subjects. RV dimensions were marginally smaller in BAs than in WAs (proximal outflow tract, 30.9±5.5 versus 32.8±5.3 mm, P<0.001; longitudinal dimension, 86.6±9.5 versus 89.8±9.6 mm, P<0.001), although only 2.3% of variation was attributable to ethnicity. RV enlargement compatible with diagnostic criteria for arrhythmogenic RV cardiomyopathy was frequently observed (proximal outflow tract ≥32 mm; 45.0% of BAs, 58.5% of WAs). Anterior T-wave inversion was present in 14.3% of BAs versus 3.7% of WAs (P<0.001). Marked RV enlargement with concomitant anterior T-wave inversion was observed in 3.0% of BAs versus 0.3% of WAs (P=0.005). Further investigation did not diagnose arrhythmogenic RV cardiomyopathy in any athlete.
  
  
  CONCLUSIONS
  Physiological RV enlargement is commonly observed in both black and white athletes. The impact of ethnicity is minimal, which obviates the need for race-specific RV reference values. However, in the context of frequent ECG repolarization anomalies in BAs, the potential for erroneous diagnosis of arrhythmogenic RV cardiomyopathy is considerably greater in this ethnic group.
authors.affiliation: St. George's University of London, London, United Kingdom.
authors.forename: Abbas
authors.initials: A
authors.lastname: Zaidi
authors.forename: Saqib
authors.initials: S
authors.lastname: Ghani
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.forename: David
authors.initials: D
authors.lastname: Oxborough
authors.forename: Vasileios F
authors.initials: VF
authors.lastname: Panoulas
authors.forename: Nabeel
authors.initials: N
authors.lastname: Sheikh
authors.forename: Sabiha
authors.initials: S
authors.lastname: Gati
authors.forename: Michael
authors.initials: M
authors.lastname: Papadakis
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D056352:Athletes; D017691:Caribbean Region / Q000208:ethnology; D017548:Echocardiography, Transesophageal / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D013177:Sports / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*; D055815:Young Adult