PhD Scientific Days 2022

Clinical Medicine I. (Poster discussion will take place in the Aula during the Coffee Break)

Biventricular mechanical pattern of the athlete’s heart: comprehensive characterization using 3D echocardiography

Text of the abstract

Regular, intense exercise results in complex morphological and functional cardiac remodeling, commonly referred to as the athlete's heart. While left ventricular (LV) adaptation is thoroughly studied, data are scarce concerning the right ventricular (RV) mechanical changes and their continuum with exercise performance.

Our aim was to characterize biventricular morphology and function and its relation to sex, age, and sports classes in a large cohort of elite athletes using 3D echocardiography (3DE).

Elite, competitive athletes (n=422) and healthy, sedentary volunteers (n=55) were enrolled. 3DE datasets were acquired to measure LV and RV end-diastolic volumes (EDVi), and ejection fractions (EF). To characterize biventricular mechanics, LV and RV global longitudinal (GLS) and circumferential strains (GCS) were quantified. All subjects underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg).

Athletes had higher LV and RV EDVi compared with controls, whereas male athletes had larger volumes than female athletes, and adult athletes had also larger LV EDVi than adolescent athletes (all p<0.05). However, RV EDVi was similar between the two age groups. Endurance athletes had larger RV EDVi compared with the other sports classes (ANOVA p<0.05).

Concerning biventricular systolic function, athletes had lower resting LV and RV EF (LV EF: 57±4 vs. 61±5%; RV EF: 55±5 vs. 59±5%; p<0.001). The exercise-induced relative decrease in LV GLS (9.5±10.7%) and LV GCS (10.7±9.8%) was similar, however, the decrement in RV GCS (14.8±17.8%) was disproportionately larger compared with RV GLS (1.7±15.4%, p<0.01). RV GCS was found to be an independent predictor of VO2/kg by multivariable linear regression.

Regular physical exercise results in significant and specific changes in LV and RV geometry and function. Resting LV mechanics of the athlete's heart is characterized by a balanced decrement in LV GLS and LV GCS, however, RV GCS decreases disproportionately compared with RV GLS. Moreover, this mechanical pattern is associated with better exercise capacity.

Financed by the Development of scientific workshops of medical, health sciences and pharmaceutical educations project (EFOP-3.6.3-VEKOP-16-2017-00009), Semmelweis University and A.F. was supported by the ÚNKP-21-3-I New National Excellence Program of the Ministry for Innovation and Technology.