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Eur Heart J Cardiovasc Imaging. 2016 Mar;17(3):301-7. doi: 10.1093/ehjci/jev155. Epub 2015 Jun 18.

Right ventricular remodelling induced by exercise training in competitive athletes.

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Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, Siena 53100, Italy
Institute of Sports Medicine and Science, Rome, Italy.
Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, Siena 53100, Italy.
Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy.



Conflicting evidence exists concerning right ventricular (RV) morphological and functional remodelling in trained athletes, with a very few longitudinal data prospectively investigating the RV changes. The aim of this study was to assess the morphological and functional RV changes occurring during the competitive season in young athletes engaged in the most popular team sports.


Twenty-nine top-level athletes (age: 20.9 ± 6.7 years), practicing basketball and volleyball, were evaluated at pre-season, mid-season, and end-season time-points, using tissue Doppler imaging and 2D speckle-tracking echocardiography. RV basal and mid-cavity end-diastolic diameters (EDDs; overall P = 0.011 and P < 0.0001, respectively), and RV diastolic area (overall P < 0.0001) increased during the season. Conversely, RV outflow tract did not vary (overall P = 0.96). During the season, no significant differences were observed in RV diastolic functional indexes and in RV fractional area change (overall P = 0.35). Global RV longitudinal strain did not significantly change (overall P = 0.52), although apical longitudinal strain significantly increased (overall P = 0.017). In association, left ventricular (LV) volume and mass increased during the season (overall P = 0.007). On multivariate analysis, LV mass was the only independent predictor of RVEDD at pre-season (β = 0.69, P < 0.0001) and at end-season (β = 0.82, P < 0.0001).


Right ventricular chamber size increases during the competitive season in top-level athletes, with no significant changes in the outflow tract. RV morphological adaptation in top-level athletes practicing team sports is not associated with a reduction in RV function or in myocardial deformation and occurs in close association with changes on the left ventricle, suggesting a physiological remodelling of the right ventricle.


Arrhythmogenic right ventricular dysplasia; Athlete's heart; Exercise conditioning; Speckle-tracking echocardiography; Strain

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