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A difficult puzzle: Right ventricular remodeling in athletes
International Journal of Cardiology 103 (2005) 114 www.elsevier.com/locate/ijcard
Letter to the Editor
A difficult puzzle: Right ventricular remodeling in athletes Erdem KasikciogluT Resitpasa caddesi Salkim sokak No=2/5 (PK 9), Istanbul University, Sports Medicine Department, Avcilar, 34840 Istanbul, Turkey Received 27 June 2004; accepted 11 November 2004 Available online 8 February 2005
I read with great interest report, Owen and colleagues [1] present data obtained in athletes indicating that peak early velocity of the atrioventricular plane (Em) of right ventricle (RV) was found to decline in endurance athletes but not in untrained subjects. As opposed to the previous study, the main result of their study, which shows lower RV diastolic function (especially Em) in athletes, is a surprise, is not clear, thus needs more explaining. Echocardiography estimation of RV is not easy to achieve due to the complex anatomy and geometry of the right ventricle, making the evaluation of its function limited. Although previous studies have shown that the morphology and function of left ventricle (LV) are adapted to chronic exercise training with changing preload and afterload factors [2,3], few echocardiographic reports have defined changes in the RV induced by training [4–7]. We previously reported that the myocardial performance index of RV was supernormal in endurance athletes with morphological adaptation of it, like LV [6]. What is more, D’Andrea et al. [7] found that RV Em in endurance athletes was higher than that of strength-trained athletes. Furthermore, they also suggested Em peak velocity of RV tricuspid annulus was independently and positively associated to LV end-diastolic diameter, and RV Em peak velocity is a powerful independent determinant [7]. They also explained that Em peak velocity is expressions of changes in atrial to pressure gradient as well as of passive diastolic properties of ventricular walls; its increase in endurance training athletes indicates a training-induced improvement of RV compliance. More-
T Tel.: +90 216 3405316; fax: +90 216 3405316. E-mail address: [email protected]. 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2004.11.003
over, they speculated that RV Em increase might be partially responsible of a better RV diastolic filling, able to induce a better RV chamber relaxation which might support increasing RV and LV stroke volume [7]. In conclusion, I believe that RV adaptation to habitual exercise is similar to changes of LV. Myocardial performance index and Em of RV may use simple, reliable and easy echocardiographic methods for follow-up of exercise training.
References [1] Owen A, Theakston SC, O’Donovan G, Bird SR. Right and left ventricular diastolic function of male endurance athletes. Int J Cardiol 2004;95:231 – 5. [2] Maron BJ. Structural features of the athlete’s heart as defined by echocardiography. J Am Coll Cardiol 1986;7:190 – 203. [3] Palazzuoli A, Pucetti L, Pastorelli M, Pasqui AL, Auteri A, Bruni F. Transmitral and pulmonary flow study in elite male runners and young adults. Int J Cardiol 2002;84:47 – 51. [4] Henriksen E, Landelius J, Wesslen L, et al. Echocardiographic right and left ventricular measurements in male elite endurance athletes. Eur Heart J 1996;17:1121 – 8. [5] Henricksen E, Landelius J, Kangro T, et al. An echocardiographic study of right and left ventricular adaptation to physical exercise in elite female orienteers. Eur Heart J 1999;20:309 – 16. [6] Kasikcioglu E, Oflaz H, Akhan H, et al. Right ventricular Tei index in athletes. Echocardiography 2004;21:373. [7] D’Andrea A, Caso P, Sarubbi B, et al. Right ventricular adaptation to different training protocols in top-level athletes. Echocardiography 2003;20:329 – 36.
Letter to the Editor
A difficult puzzle: Right ventricular remodeling in athletes Erdem KasikciogluT Resitpasa caddesi Salkim sokak No=2/5 (PK 9), Istanbul University, Sports Medicine Department, Avcilar, 34840 Istanbul, Turkey Received 27 June 2004; accepted 11 November 2004 Available online 8 February 2005
I read with great interest report, Owen and colleagues [1] present data obtained in athletes indicating that peak early velocity of the atrioventricular plane (Em) of right ventricle (RV) was found to decline in endurance athletes but not in untrained subjects. As opposed to the previous study, the main result of their study, which shows lower RV diastolic function (especially Em) in athletes, is a surprise, is not clear, thus needs more explaining. Echocardiography estimation of RV is not easy to achieve due to the complex anatomy and geometry of the right ventricle, making the evaluation of its function limited. Although previous studies have shown that the morphology and function of left ventricle (LV) are adapted to chronic exercise training with changing preload and afterload factors [2,3], few echocardiographic reports have defined changes in the RV induced by training [4–7]. We previously reported that the myocardial performance index of RV was supernormal in endurance athletes with morphological adaptation of it, like LV [6]. What is more, D’Andrea et al. [7] found that RV Em in endurance athletes was higher than that of strength-trained athletes. Furthermore, they also suggested Em peak velocity of RV tricuspid annulus was independently and positively associated to LV end-diastolic diameter, and RV Em peak velocity is a powerful independent determinant [7]. They also explained that Em peak velocity is expressions of changes in atrial to pressure gradient as well as of passive diastolic properties of ventricular walls; its increase in endurance training athletes indicates a training-induced improvement of RV compliance. More-
T Tel.: +90 216 3405316; fax: +90 216 3405316. E-mail address: [email protected]. 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2004.11.003
over, they speculated that RV Em increase might be partially responsible of a better RV diastolic filling, able to induce a better RV chamber relaxation which might support increasing RV and LV stroke volume [7]. In conclusion, I believe that RV adaptation to habitual exercise is similar to changes of LV. Myocardial performance index and Em of RV may use simple, reliable and easy echocardiographic methods for follow-up of exercise training.
References [1] Owen A, Theakston SC, O’Donovan G, Bird SR. Right and left ventricular diastolic function of male endurance athletes. Int J Cardiol 2004;95:231 – 5. [2] Maron BJ. Structural features of the athlete’s heart as defined by echocardiography. J Am Coll Cardiol 1986;7:190 – 203. [3] Palazzuoli A, Pucetti L, Pastorelli M, Pasqui AL, Auteri A, Bruni F. Transmitral and pulmonary flow study in elite male runners and young adults. Int J Cardiol 2002;84:47 – 51. [4] Henriksen E, Landelius J, Wesslen L, et al. Echocardiographic right and left ventricular measurements in male elite endurance athletes. Eur Heart J 1996;17:1121 – 8. [5] Henricksen E, Landelius J, Kangro T, et al. An echocardiographic study of right and left ventricular adaptation to physical exercise in elite female orienteers. Eur Heart J 1999;20:309 – 16. [6] Kasikcioglu E, Oflaz H, Akhan H, et al. Right ventricular Tei index in athletes. Echocardiography 2004;21:373. [7] D’Andrea A, Caso P, Sarubbi B, et al. Right ventricular adaptation to different training protocols in top-level athletes. Echocardiography 2003;20:329 – 36.