RV and LV Function and Mass in Male Elite Master Athletes
What cardiac structure and function (with special focus on the right ventricle [RV]) is found using contrast-enhanced cardiovascular magnetic resonance (CMR) imaging in long-term elite master endurance athletes?
A cohort of 33 healthy Caucasian competitive elite male master endurance athletes (age range 30-60 years) with a training history of 29 ± 8 years; and 33 Caucasian control subjects pair-matched for age, height, and weight underwent cardiopulmonary exercise testing, echocardiography including tissue-Doppler imaging and speckle tracking, and CMR. Left ventricular (LV) and RV volumes and mass were indexed to body surface area.
Compared to the control group, elite master athletes had greater LV end-diastolic volume index (104 ± 13 vs. 69 ± 18 ml/m2, p < 0.001) and mass index (96 ± 13 vs. 62 ± 10 g/m2, p < 0.001), and greater RV end-diastolic volume index (110 ± 22 vs. 66 ± 16 ml/m2, p < 0.001) and RV mass index (36 ± 7 vs. 24 ± 5 g/m2, p < 0.001). RV ejection fraction (EF) did not differ between athletes and controls (52 ± 8 vs. 54 ± 6 %, p = 0.26). Pathological late enhancement was detected in one athlete. No correlations were found for LV and RV volumes and EF with N-terminal pro-B-type natriuretic peptide, and high-sensitivity troponin was negative in all subjects.
Based on these results, the authors concluded that chronic RV damage in elite endurance master athletes with lifelong high training volumes is unlikely. Based on this, the authors question the hypothesis of an exercise-induced arrhythmogenic RV cardiomyopathy (ARVC).
Previous studies have demonstrated that prolonged strenuous exercise such as a marathon, ultramarathon, or triathlon can be associated with acute but transient reduction in RVEF and elevation of cardiac biomarkers of myocardial injury. Because one study found a high prevalence of RV structural and/or arrhythmic involvement in endurance athletes evaluated for symptoms of palpitations or dizziness, an acquired (exercise-induced) ARVC was hypothesized. These data suggest that, among this population of endurance athletes, an acquired/exercise-induced ARVC does not seem likely. It is unknown whether other (possibly genetic) factors also could play a role in hypothesized longer-term structural changes associated with prolonged exercise.
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