RV Remodeling in Olympic Athletes

Study Questions:

How do sex and different sports affect right ventricular (RV) remodeling?


A cohort of 1,009 Olympic athletes from the Italian teams qualified for participation in the 2012 Summer or the 2014 Winter Olympic Games (mean age 24 ± 6 years; n = 647 [64%] males) participating in skill, power, mixed, and endurance sports were evaluated by two-dimensional echocardiography and Doppler/tissue Doppler imaging. The proximal and subvalvular RV outflow tract (RVOT) diameters were respectively measured in parasternal long-axis (PLAX) and short-axis (SAX) views; and RV fractional area change, sʹ velocity, and morphological features were assessed.


PLAX RVOT diameter indexed to body surface area was greater in females than in males (15.3 ± 2.2 mm/m2 vs. 14.4 ± 1.9 mm/m2; p < 0.001). Both PLAX RVOT and SAX RVOT diameters were significantly different among skill, power, mixed, and endurance sports: 14.3 ± 2.1 mm/m2 vs. 14.7 ± 1.9 mm/m2 vs. 14.0 ± 1.8 mm/m2 vs. 15.7 ± 2.2 mm/m2, respectively (p < 0.001); and 15.2 ± 2.7 mm/m2 vs. 15.3 ± 2.4 mm/m2 vs. 14.8 ± 2.1 mm/m2 vs. 16.2 ± 2.5 mm/m2, respectively (p < 0.001). The 95th percentiles for indexed PLAX RVOT and SAX RVOT were 18 mm/m2 and 20 mm/m2, respectively. RV fractional area change and sʹ velocity did not differ among the groups (p = 0.34 for both). RV enlargement compatible with major and minor Task Force diagnostic criteria for arrhythmogenic RV cardiomyopathy was observed in 41 (4%) and 319 (32%) athletes. A rounded apex was described in 823 (81%) athletes, prominent trabeculations in 378 (37%) athletes, and a prominent/hyper-reflective moderator band in 5 (0.5%) athletes.


RV remodeling occurs in Olympic athletes, with sex and endurance practice apparently having major influences. A significant subset (up to 32%) of athletes exceeds the normal Task Force limits. Based on that, the authors recommend referring to the 95th percentiles reported in this study as referral values; alternatively, the authors suggest that it is possible that only major diagnostic Task Force criteria for arrhythmogenic RV cardiomyopathy might be appropriate.


It seems logical that the type of sport influences athletic RV remodeling; and not surprising that, indexing to the customary but flawed body surface area, indexed measurements differ between sexes. However, race also places a significant role in many other features of athletic cardiac remodeling. Although the authors recommend that these specific data (derived from the Italian Olympic teams in 2012 and 2014) could be extrapolated to all athletes, it might be appropriate to also establish data specific to race.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Sports and Exercise Cardiology, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Echocardiography/Ultrasound, Sports and Exercise and Imaging

Keywords: Arrhythmogenic Right Ventricular Dysplasia, Athletes, Body Surface Area, Cardiomyopathies, Diagnostic Imaging, Echocardiography, Echocardiography, Doppler, Hypertrophy, Right Ventricular, Sports, Ventricular Remodeling

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