Influence of gender on right ventricle adaptation to endurance exercise: an ultrasound two-dimensional speckle-tracking stress study.
BACKGROUND
Characteristic right ventricle (RV) remodelling is related to endurance exercise in male athletes (MAs), but data in female athletes (FAs) are scarce. Our aim was to evaluate sex-related influence on exercise-induced RV remodelling and on RV performance during exercise.


METHODS
Forty endurance athletes (>10 training hours/week, 50% female) and 40 age-matched controls (<3 h moderate exercise/week, 50% female) were included. Echocardiography was performed at rest and at maximum cycle-ergometer effort. Both ventricles were analysed by standard and speckle-tracking echocardiography.


RESULTS
Endurance training induced similar structural and functional cardiac remodelling in MAs and FAs, characterized by bi-ventricular dilatation [~34%, left ventricle (LV); 29%, RV] and normal bi-ventricular function. However, males had larger RV size (p < 0.01), compared to females: RV end-diastolic area (cm2/m2): 15.6 ± 2.2 vs 11.6 ± 1.7 in athletes; 12.2 ± 2.7 vs 8.6 ± 1.6 in controls, respectively, and lower bi-ventricular deformation (RV global longitudinal strain (GLS) (%): -24.0 ± 3.6 vs -29.2 ± 3.1 in athletes; -24.9 ± 2.5 vs -30.0 ± 1.9 in controls, and LVGLS: -17.5 ± 1.4 vs -21.9 ± 1.9 in athletes; -18.7 ± 1.2 vs -22.5 ± 1.5 in controls, respectively, p < 0.01). During exercise, the increase in LV function was positively correlated (p < 0.01) with increased cardiac output (∆%LV ejection fraction, r = +0.46 and ∆%LVGLS, r = +0.36). Improvement in RV performance was blunted at high workloads, especially in MAs.


CONCLUSIONS
Long-term endurance training induced similar bi-ventricular remodelling in MAs and FAs. Independently of training load, males had larger RV size and lower bi-ventricular deformation. Improvement in RV performance during exercise was blunted at high workloads, especially in MAs. The potential mechanisms underlying these findings warrant further investigation.
Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain. meriluprime@hotmail.com.
Maria
http://orcid.org/0000-0003-3199-9577
M
Sanz-de la Garza
Montreal Heart Institute, Montreal, Canada.
Geneviève
G
Giraldeau
Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain.
Josefa
J
Marin
Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain.
Gonzalo
G
Grazioli
Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain.
Montserrat
M
Esteve
Catolic University of Chile, Santiago De Chile, Chile.
Luigi
L
Gabrielli
Angeles del Carmen Hospital, Guadalajara, Mexico.
Carlos
C
Brambila
Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain.|Montreal Heart Institute, Montreal, Canada.|Catolic University of Chile, Santiago De Chile, Chile.|Angeles del Carmen Hospital, Guadalajara, Mexico.|ICREA, Universitat Pompeu Fabra, Barcelona, Spain.
Laura
L
Sanchis
ICREA, Universitat Pompeu Fabra, Barcelona, Spain.
Bart
B
Bijnens
Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain.
Marta
M
Sitges
D000222:Adaptation, Physiological; D000328:Adult; D016022:Case-Control Studies; D004452:Echocardiography; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D016278:Ventricular Function, Right
Athlete’s heart; Endurance training; Exercise; Right ventricle; Sex