Left and Right Ventricular Morphology and Function in Athletes With Elevated Pulmonary Systolic Arterial Pressure

Echocardiography. 2018 Jun;35(6):769-776. doi: 10.1111/echo.14016. Epub 2018 May 11.

Abstract

Objectives: The objective of the study was to evaluate the prevalence and potential impact of elevated pulmonary arterial systolic pressure (PASP) on left and right cardiac morphology and function in young elite athletes.

Methods: In total, 85 professional athletes (40 endurance, 20 strength, and 25 mixed training, mean age 17.8 ± 4.0) and 50 sedentary controls (mean age 18.6 ± 3.3) underwent transthoracic echocardiographic examination. Two-dimensional measurements of the right (RV) and left ventricle (LV) were obtained. PASP was estimated from the peak tricuspid regurgitant velocity (TRV). Speckle tracking-derived longitudinal LV and RV strain measurements (RV_LS) were calculated for function estimation.

Results: Maximum TRV (2.2 ± 0.3 vs 2.0 ± 0.2 m/s, P < .01) and PASP (26 ± 5 vs 22 ± 5 mm Hg, P < .01) were higher in athletes compared to controls. PAPS above 30 mm Hg (35 ± 3 mm Hg, range 31-40 mm Hg) was identified in 11 athletes (12.9%). Athletes with elevated PASP demonstrated higher LV mass (P < .01), LV stroke volume indexed (P < .01), larger RV-end-systolic area (ESAi), RV-end-diastolic area (EDAi), right atrium ES volume and ED volume, and decreased RV fractional area change (FAC) (P < .01) when compared to matched controls and higher RV-EDAi (13.0 ± 1.6 vs 11.1 ± 1.5, P < .01), RV-ESAi (8.2 ± 1.5 vs 6.1 ± 0.9, P < .01), and significantly reduced RV FAC (38.1 ± 5.8 vs 44.6 ± 2.5, P < .01) when compared to matched athletes. LV global longitudinal strain and RV_LS showed no differences between the groups.

Conclusions: Pulmonary arterial systolic pressure elevation in young athletes is associated with pronounced right ventricular enlargement, even when compared to matched athletes. Conventional and speckle tracking echocardiography showed preserved right ventricular function.

Keywords: athlete's heart; cardiac imaging; echocardiography; pulmonary artery hypertension; speckle tracking echocardiography.

MeSH terms

  • Athletes*
  • Echocardiography / methods
  • Exercise / physiology*
  • Female
  • Follow-Up Studies
  • Heart Ventricles / diagnostic imaging*
  • Humans
  • Male
  • Prospective Studies
  • Pulmonary Wedge Pressure / physiology*
  • Reference Values
  • Stroke Volume / physiology*
  • Ventricular Function, Left / physiology
  • Ventricular Function, Right / physiology*