title: Nonsymmetric myocardial contribution to supranormal right ventricular function in the athlete's heart: combined assessment by speckle tracking and real time three-dimensional echocardiography.
abstract: OBJECTIVE
  To investigate determinants of right ventricular (RV) function in competitive athletes by a combined assessment of speckle tracking (STE) and real time 3D echocardiography (RT3DE).
  
  
  METHODS
  Right ventricular function of 40 top-level rowers was compared to 43 sedentary normal controls by standard Doppler echocardiography, RT3DE, and STE. RV diameters and wall thickness, tricuspid annular plane systolic excursion (TAPSE), tricuspid E/A ratio, and pulsed tissue Doppler of lateral tricuspid annulus were analyzed. RV volumes, ejection fraction (EF), and stroke volume (SV) were determined. RV global longitudinal strain (GLS) (average of 6 regions), septal strain (average of 3 septal regions, septal longitudinal strain [SLS]), and lateral strain (average of 3 lateral regions, lateral longitudinal strain [LLS]) were estimated by STE.
  
  
  RESULTS
  The 2 groups were comparable for age, body mass index, and blood pressure, but heart rate was lower in rowers. RV diameters were larger and TAPSE, tricuspid E/A ratio, and tissue Doppler-derived s' and e' velocities were higher in rowers. By RT3DE, RV end-diastolic volume (EDV) and end-systolic volume were greater in rowers (both P < 0.0001), without difference in EF. GLS (P < 0.005) and LLS (P < 0.001), but not SLS, were greater in rowers. In pooled groups, LLS was related to EDV and SV, even after adjusting for heart rate, body mass index, and RV wall thickness by separate multiple linear regression analyses (β coefficient = 0.247, P < 0.01 and β = 0.225, P < 0.02, respectively).
  
  
  CONCLUSIONS
  Right ventricular preload exerts its maximal influence on the longitudinal lateral fibers, which is independent on potential confounders and largely induces RV supranormal function in the athlete's heart.
authors.affiliation: Echocardiography Laboratory, Department of Translational, Medical Sciences Federico II University, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Esposito
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Schiano-Lomoriello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Santoro
authors.forename: Daniela
authors.initials: D
authors.lastname: De Palma
authors.forename: Renato
authors.initials: R
authors.lastname: Ippolito
authors.forename: Riccardo
authors.initials: R
authors.lastname: Muscariello
authors.forename: Ciro
authors.initials: C
authors.lastname: Santoro
authors.forename: Germano
authors.initials: G
authors.lastname: Guerra
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Simone
mesh_terms: D000328:Adult; D059267:Cardiomegaly, Exercise-Induced / Q000502:physiology*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D033081:Shear Strength; D013177:Sports / Q000502:physiology*; D013314:Stress, Mechanical; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016278:Ventricular Function, Right
keywords: athlete's heart; longitudinal strain; right ventricle; speckle tracking echocardiography; three-dimensional echocardiography