Right ventricular function and region-specific adaptation in athletes engaged in high-dynamic sports: A meta-analysis
Meah, Victoria L.
Lippincott, Williams and Wilkins
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Background Structural remodeling of the right ventricle (RV) is widely documented in athletes. However, functional adaptation, including RV pressure generation and systolic free-wall longitudinal mechanics, remains equivocal. This meta-analysis compared RV pressure and function in athletes and controls. Methods A systematic review of online databases was conducted up to June 4, 2020. Meta-analyses were performed on RV systolic pressures (RVSP), at rest and during exercise, tricuspid annular plane systolic displacement (TAPSE), myocardial velocity (S’), and global and regional longitudinal strain. Bias was assessed using Egger’s regression for asymmetry. Data were analyzed using random-effects models with weighted mean difference (WMD) and 95% confidence interval (95%CI). Results Fifty-three studies were eligible for inclusion. RVSP was obtained from 21 studies at rest (n=1043:1651; controls:athletes) and 8 studies during exercise (n=240:495) and was significantly greater in athletes at rest (WMD: 2.9mmHg, CI: 1.3-to-4.5mmHg; P=0.0005) and during exercise (11.0, 6.5-to-15.6 mmHg; P<0.0001) vs. controls. Resting TAPSE (P<0.0001) and S’ (P=0.001) were greater in athletes. In contrast, athletes had similar RV free-wall longitudinal strain (17 studies; n=450:605), compared to controls, but showed greater longitudinal apical strain (16 studies; n=455:669; 0.9%, 0.1- to-1.8%;P=0.03) and lower basal strain (-2.5%, -1.4-to -3.5%;P<0.0001). Conclusions Functional RV adaptation, characterized by increased tricuspid annular displacement and velocity and a greater base-to-apex strain gradient, is a normal feature of the athlete’s heart, together with a slightly elevated RVSP. These findings contribute to our understanding of RV in athletes and highlight the importance of considering RV function in combination with structure in the clinical interpretation of the athlete’s heart.
Circulation Cardiovascular Imaging;
Article accepted for publication in Circulation Cardiovascular Imaging
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
- Sport Research Groups 
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