Clinical Investigation
Cardiac Effects of Athletic Training
Right Atrial and Ventricular Adaptations to Training in Male Caucasian Athletes: An Echocardiographic Study

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Background

The aim of this study was to investigate the systolic and diastolic properties of the right cardiac chambers (the right ventricle and right atrium) among different subsets of athletes to unveil potential variations in right ventricular and right atrial remodeling secondary to different training modes.

Methods

A cohort of Caucasian male top-level athletes (n = 108; 80 endurance athletes [EAs], mean age, 31.2 ± 10.4 years; 28 strength-trained athletes [SAs], mean age, 27.4 ± 5.7 years) and untrained controls (n = 26; mean age, 26.6 ± 5.6 years) (P = .327) were prospectively enrolled. Conventional echocardiographic parameters, including transtricuspid inflow, Doppler tissue imaging, and two-dimensionally derived peak systolic longitudinal strain and strain rate indices of the right ventricle and right atrium, were calculated.

Results

EAs had greater internal right ventricular and right atrial dimensions compared with SAs and controls. There were no significant differences concerning strain between groups (−23.1 ± 3.7% in EAs vs −25.1 ± 3.2% in SAs vs −23.1 ± 3.5% in controls, P = .052), with SAs presenting higher global systolic strain rates (−1.42 ± 0.22 sec−1 in SAs vs −1.21 ± 0.21 sec−1 in EAs vs −1.2 ± 0.28 sec−1 in controls, P = .016), as well as greater right atrial strain rate systolic and diastolic components. Training volume (highly vs moderately trained athletes) did not significantly influence deformation parameters. No significant differences concerning diastolic transtricuspid inflow and Doppler tissue imaging indices were also noted among different athlete groups and controls.

Conclusions

Despite the existence of right geometric alterations in athletes participating in different sport disciplines, few meaningful differences in deformation and diastolic function exist.

Section snippets

Study Population

This was a prospective study designed and performed in Thessaloniki, in northern Greece, during the peak competitive seasons of 2011 and 2012. After contacting the National Federations of Sports as well as sports physicians and coaches of the top-level sports teams in northern Greece, asking to recruit athletes competing in national-level and international-level training in our region, 108 Caucasian male top-level athletes in different sport disciplines volunteered to participate in our study.

Basic Demographic and Standard LV Morphologic Parameters

Age, anthropometric data, clinical characteristics, and performance measures of the study population are shown in Table 1. No significant differences concerning age and body habitus parameters between athletes and controls were recorded. As expected, athletes presented, because of exercise-induced remodeling, greater internal dimensions (LV end-diastolic diameter and volume) and LV mass index compared with controls (LV end-diastolic diameter, 5.3 ± 0.35 cm in EAs vs 5 ± 0.38 cm in SAs vs

Discussion

Systematic training imposes a wide range of adaptations, structural and functional, affecting both ventricles and atria.1, 2 Concerning the right ventricle, geometric remodeling secondary to systematic training has been described in previous studies, while ambiguous results exist regarding deformation and diastolic function of the right ventricle among athletes, suggesting that observed changes could be attributed either to an acquired right cardiomyopathy secondary to long-term intensive

Conclusions

Systematic training imposes physiologic, morphologic, and functional adaptations on the right ventricle and right atrium. Despite differences in geometric remodeling among different subsets of athletes (EAs vs SAs, highly vs moderately trained athletes, with or without RV dilatation) and untrained controls, few meaningful differences in right cardiac cavity deformation and relaxation exist, suggesting that RV and RA systolic and diastolic function in athletes, irrespective of sport discipline,

Acknowledgments

We thank all the athletes and healthy volunteers participating in the study. Additionally, we thank Vourdounis Nikos and Dimitrakopoulos Ioannis, local GE staff members, for their continuous technical support with EchoPAC software, along with the nurses and aid personnel of the Third Cardiology Department's Acute Coronary Unit for their commitment to completion of the current research protocol.

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    Dr. Pagourelias has received a postdoctoral research scholarship from the Research Committee of the Aristotle University of Thessaloniki, Greece.

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