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Exercise-Induced Right Heart Disease in Athletes

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The Right Ventricle in Health and Disease

Part of the book series: Respiratory Medicine ((RM))

Abstract

There is little doubt about the health benefits of exercise on, not only the cardiorespiratory system, but also on mental health, bone health, and overall mortality risk (Circulation 116:1081–93, 2007). Most of the data supporting the pleotropic benefits of exercise are derived from large observational studies of cohorts engaged in exercise of limited duration and of mild-to-moderate intensity. There is also evidence that these health benefits extend to athletes participating in high-level training and competition (Eur Heart J 34:3145–50, 2013; JAMA 285:44–5, 2001; Med Sci Sports Exerc 25:237–44, 1993), although it is difficult to determine whether it is the healthy lifestyle and absence of comorbidities (the ‘healthy cohort effect’) or exercise itself which is the main determinant of the observed improvements in longevity (Curr Sports Med Rep 12:63–9, 2013). Intense physical training promotes changes in cardiac structure, function, and electrical conduction termed the “athlete’s heart” and, whilst many of these changes are considered physiological and healthy, there is increasing concern that more extreme exercise may promote permanent changes in myocardial structure and that a small number of athletes may be predisposed to arrhythmias, such as atrial fibrillation (Curr Sports Med Rep 12:63–9, 2013; Europace 11:1156–9, 2009; Heart 96:398–405, 2010). To date, much of the research regarding athlete’s heart has focused on the left ventricle (LV), but there is evolving evidence that the right ventricle (RV) is of even greater importance in understanding the hemodynamic stressors on the heart during intense exercise and in understanding the potential arrhythmia complications.

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Authors and Affiliations

  1. Department of Cardiology, St Vincent’s Hospital, University of Melbourne, Fitzroy, VIC, Australia

    David Prior M.B.B.S., Ph.D., F.R.A.C.P., D.D.U., F.C.S.A.N.Z

  2. Department of Medicine, St Vincent’s Hospital, University of Melbourne, Fitzroy, VIC, Australia

    Andre La Gerche M.B.B.S., F.R.A.C.P., Ph.D.

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  2. Andre La Gerche M.B.B.S., F.R.A.C.P., Ph.D.
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Correspondence to David Prior M.B.B.S., Ph.D., F.R.A.C.P., D.D.U., F.C.S.A.N.Z .

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Editors and Affiliations

  1. Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA

    Norbert F. Voelkel

  2. Pediatric Heart Center, Justus-Liebig University, Giessen, Germany

    Dietmar Schranz

Electronic Supplementary Material

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Rest and exercise cardiac magnetic resonance images comparing a nonathlete, an endurance athlete, and a patient with pulmonary hypertension. Note the relative dilation of the athlete’s RV. The remodeling approaches that of the patient with pulmonary hypertension, presumably because the hemodynamic stress of exercise shares some similarities with the high RV afterload state of pulmonary hypertension. Further insights are provided during exercise where the ventricular interdependence can readily be appreciated with profound septal shift toward the LV in the patient with pulmonary hypertension but, again, a tendency for a similar pattern in the athlete (MP4 681 kb)

Video 15.2

Examples of cardiac function and RV remodeling in four professional cyclists. Profound cardiac remodeling can be observed amongst these four elite cyclists. These examples were all obtained from a single session of screening world-class asymptomatic athletes. Athlete 1 has RV dilation and apical hypokinesis. In athletes 2 and 4 there is marked RV hypertrophy, with very prominent apical trabeculation in the latter. Apical rocking is demonstrated in athlete 3, a finding that usually indicates dyssynchronous or unbalanced ventricular contraction (MP4 874 kb)

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Prior, D., La Gerche, A. (2015). Exercise-Induced Right Heart Disease in Athletes. In: Voelkel, N., Schranz, D. (eds) The Right Ventricle in Health and Disease. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1065-6_15

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