scholarly journals Exercise-induced shift in right ventricular contraction pattern: novel marker of athlete’s heart?

2018 ◽  
Vol 315 (6) ◽  
pp. H1640-H1648 ◽  
Author(s):  
Bálint Károly Lakatos ◽  
Orsolya Kiss ◽  
Márton Tokodi ◽  
Zoltán Tősér ◽  
Nóra Sydó ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Athlete’S Heart ◽  
Longitudinal Motion ◽  
Contraction Pattern ◽  
Control Subjects ◽  
Relative Contribution ◽  
Functional Shift ◽  
The Right ◽  
Athlete's Heart

Data about the functional adaptation of the right ventricle (RV) to intense exercise are limited. Our aim was to characterize the RV mechanical pattern in top-level athletes using three-dimensional echocardiography. A total of 60 elite water polo athletes (19 ± 4 yr, 17 ± 6 h of training/wk, 50% women and 50% men) and 40 healthy sedentary control subjects were enrolled. We measured the RV end-diastolic volume index (RVEDVi) and ejection fraction (RVEF) using dedicated software. Furthermore, we determined RV global longitudinal (RV GLS) and circumferential strain (RV GCS) and the relative contribution of longitudinal ejection fraction (LEF) and radial ejection fraction (REF) to RVEF using the ReVISION method. Athletes also underwent cardiopulmonary exercise testing [O2 consumption (V̇o2)/kg]. Athletes had significantly higher RVEDVi compared with control subjects (athletes vs. control subjects, 88 ± 11 vs. 65 ± 10 ml/m2, P < 0.001); however, they also demonstrated lower RVEF (56 ± 4% vs. 61 ± 5%, P < 0.001). RV GLS was comparable between the two groups (−22 ± 5% vs. −23 ± 5%, P = 0.24), whereas RV GCS was significantly lower in athletes (−21 ± 4% vs. −26 ± 7%, P < 0.001). Athletes had higher LEF and lower REF contribution to RVEF (LEF/RVEF: 0.50 ± 0.07 vs. 0.42 ± 0.07, P < 0.001; REF/RVEF: 0.33 ± 0.08 vs. 0.45 ± 0.08, P < 0.001). Moreover, the pattern of RV functional shift correlated with V̇o2/kg (LEF/RVEF: r = 0.30, P < 0.05; REF/RVEF: r = −0.27, P < 0.05). RV mechanical adaptation to long-term intense exercise implies a functional shift; the relative contribution of longitudinal motion to global function was increased, whereas the radial shortening was significantly decreased, in athletes. Moreover, this functional pattern correlates with aerobic exercise performance, representing a potential new resting marker of an athlete’s heart. NEW & NOTEWORTHY Intensive regular physical exercise results in significant changes of right ventricular morphology and function. By separate quantification of the right ventricular longitudinal and radial function, a relative dominance of longitudinal motion and a decrease in radial motion can be observed compared with sedentary controls. Moreover, this contraction pattern correlates with cardiopulmonary fitness. According to these results, this functional shift of the right ventricle may represent a novel marker of an athlete’s heart.

scholarly journals 3081Exercise-induced shift in right ventricular contraction pattern: novel marker of athlete's heart?

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
B K Lakatos ◽  
O Kiss ◽  
M Tokodi ◽  
Z Toser ◽  
N Sydo ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Athlete’S Heart ◽  
Ventricular Contraction ◽  
Contraction Pattern ◽  
Athlete's Heart

Right Heart Phenotype in Heart Failure With Preserved Ejection Fraction

2021 ◽  
Author(s):  
Marco Guazzi ◽  
Robert Naeije
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Right Ventricular Dysfunction ◽  
Preserved Ejection Fraction ◽  
Right Heart ◽  
The Right

The health burden of heart failure with preserved ejection fraction is increasingly recognized. Despite improvements in diagnostic algorithms and established knowledge on the clinical trajectory, effective treatment options for heart failure with preserved ejection fraction remain limited, mainly because of the high mechanistic heterogeneity. Diagnostic scores, big data, and phenomapping categorization are proposed as key steps needed for progress. In the meantime, advancements in imaging techniques combined to high-fidelity pressure signaling analysis have uncovered right ventricular dysfunction as a mediator of heart failure with preserved ejection fraction progression and as major independent determinant of poor outcome. This review summarizes the current understanding of the pathophysiology of right ventricular dysfunction in heart failure with preserved ejection fraction covering the different right heart phenotypes and offering perspectives on new treatments targeting the right ventricle in its function and geometry.

scholarly journals P798 Right atrial phasic function and correlation with right ventricular function in patients with reduced left ventricular ejection fraction and no pulmonary hypertension:insights from 3D echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A E Vijiiac ◽  
D Muraru ◽  
F Jarjour ◽  
K Kupczynska ◽  
C Palermo ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Pump Function ◽  
The Right ◽  
Conduit Function

Abstract Background The right atrium (RA) is a highly dynamic chamber with 3 mechanical functions (reservoir, conduit, booster pump) and prognostic implications in heart failure (HF) and pulmonary hypertension (PH). However, RA function and its interplay with the right ventricular (RV) performance in patients (pts) with reduced left ventricular ejection fraction (LVEF) and without PH remain to be clarified. Methods We used three-dimensional echocardiography to study 55 pts (61 ± 14 years, 43 men) with LVEF &lt; 40% no more than mild tricuspid regurgitation (TR), and maximum velocity of the TR jet &lt; 3 m/s. We measured the three-dimensional RA total, passive, active ejection volumes (EV) and the respective emptying fractions (EF). In addition, we compared RV volumes and ejection fraction (RVEF) between patients with normal and abnormal RA function. Results Mean LVEF was 30 ± 7%. Mean echo-derived pulmonary vascular resistance was 1.64 ± 0.54 Wood units. 28 pts (51%) had reduced RA reservoir function (total EF = 34 ± 9%), 34 pts (62%) had reduced RA conduit function (passive EF = 15 ± 4%), and 10 pts (18%) had reduced RA pump function (active EF = 11 ± 3%). Pts with reduced RA reservoir function showed larger RV end-systolic volume (RVESV 124 ± 48ml vs. 90 ± 32ml; p = 0.004) and lower RVEF (38 ± 8% vs. 46 ± 6%; p &lt; 0.001) than pts with normal RA function. Pts with reduced RA conduit function showed smaller RV stroke volume (RVSV 65 ± 19 ml vs. 80 ± 22ml; p = 0.009). Pts with impaired RA pump function showed larger RVESV (142 ± 45ml vs. 99 ± 41ml; p = 0.02) and lower RVEF (36 ± 6% vs. 43 ± 8%; p = 0.006). RVESV was positively correlated with total (r2 = 0.47, p &lt; 0.001), passive (r2 = 0.29, p = 0.03) and active (r2 = 0.39, p = 0.003) RAEV, while it was negatively correlated with total (r2=-0.41, p = 0.002), passive (r2=-0.34, p = 0.01) and active (r2=-0.31, p = 0.02) RAEF. RVSV showed a positive correlation with both total (r2 = 0.4, p = 0.002) and passive (r2 = 0.41, p = 0.002) RAEV. Finally, RVEF was positively correlated with total (r2 = 0.51, p &lt; 0.001), passive (r2 = 0.47, p &lt; 0.001), and active (r2 = 0.36, p = 0.007) RAEF. Conclusions RA dysfunction is not uncommon in pts with reduced LVEF, even in the absence of PH. In these pts, RA function is associated with significant changes in RV function. The RA acts as a dynamic modulator of RV pump function by redistributing RV filling and ejection force among reservoir, conduit and pump functions in the setting of altered hemodynamics. The clinical and prognostic significance of RA function in pts with reduced LVEF warrant further studies.

Effect of pacing the right ventricular mid-septum tract in patients with permanent atrial fibrillation and low ejection fraction

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S29
Author(s):  
Cosimo Sacra ◽  
Carmine Muto ◽  
Giovanni Carreras ◽  
Michelangelo Canciello ◽  
Luigi Ascione ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Permanent Atrial Fibrillation ◽  
The Right ◽  
Low Ejection Fraction

Athletic Training and Arrhythmogenic Right Ventricular Cardiomyopathy

2019 ◽  
Vol 40 (05) ◽  
pp. 295-304 ◽  
Author(s):  
Sara Coelho ◽  
Filipe Silva ◽  
Joana Silva ◽  
Natália António
Keyword(s):  
Right Ventricular ◽  
Athletic Training ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Right Ventricular Dysfunction ◽  
Athlete’S Heart ◽  
Ventricular Cardiomyopathy ◽  
Inherited Cardiomyopathy ◽  
Arrhythmogenic Substrate ◽  
History Of ◽  
Athlete's Heart

AbstractArrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden death in the young and in competitive athletes. The deleterious role of exercise in the natural history of ARVC is clear. Even in the absence of a demonstrated arrhythmogenic substrate, family history or mutations of ARVC, intense physical exercise may in some individuals lead to the development of right ventricular dysfunction and arrhythmogenicity. This led to question the benignity of some adaptive features of the athlete's heart. In fact, there is an overlap between typical aspects of the athlete's heart and pathological changes described in ARVC, being challenging to distinguish the two conditions. The aim of this review is to highlight the aspects that help to distinguish between athlete's heart and ARVC, to review the major findings on exams helping in the differential diagnosis and to determine the implications on eligibility for leisure and competitive sports.

Effect of Pacing the Right Ventricular Mid-Septum Tract in Patients with Permanent Atrial Fibrillation and Low Ejection Fraction

2007 ◽  
Vol 18 (10) ◽  
pp. 1032-1036 ◽  
Author(s):  
CARMINE MUTO ◽  
LUCA OTTAVIANO ◽  
MICHELANGELO CANCIELLO ◽  
GIOVANNI CARRERAS ◽  
RAIMONDO CALVANESE ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Permanent Atrial Fibrillation ◽  
The Right ◽  
Low Ejection Fraction

A novel diagnostic score to differentiate between athlete"s heart and ARVC

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
VA Rossi ◽  
D Niederseer ◽  
JM Sokolska ◽  
B Kovacs ◽  
S Costa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Right Ventricular ◽  
Task Force ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Clinical Score ◽  
Athlete’S Heart ◽  
Clinical Parameters ◽  
Diagnostic Score ◽  
Funding Sources ◽  
Athlete's Heart

Abstract Funding Acknowledgements Type of funding sources: None. Background The 2010 Task Force Criteria (TFC), although representing the current gold standard to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC), have not been tested to differentiate ARVC from the athlete’s heart. Furthermore, not all 6 diagnostic categories are easy to obtain. Purpose We hypothesized that atrial dimensions are useful to differentiate between both entities. Therefore, we developed a new diagnostic score based upon readily available clinical parameters including atrial dimensions on TTE to help distinguishing the athlete’s heart from ARVC in daily clinical practice. Methods In this observational study, 37 patients with definite ARVC (from the Zurich ARVC Program) were compared to 68 athletes. Base on ROC analysis, the following echocardiographic, laboratory and electrocardiographic parameters were included in the final score: indexed right/left atrial volumes (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX adjusted for BSA) on TTE, tricuspid annular motion velocity (TAM) on TTE, precordial electrocardiographic T-wave inversions and depolarization abnormalities according to the TFC. Results ARVC patients had a higher RAVI/LAVI ratio (1.78 ± 1.6vs0.95 ± 0.3,p &lt; 0.001), lower right-ventricular function (fac:28 ± 9.7vs42.1 ± 4.8%,p &lt; 0.001; TAM:17.9 ± 5.6vs23.3 ± 3.7mm,p &lt; 0.001) and higher serum NT-proBNP levels (491 ± 771vs44.8 ± 50.6ng/l,p &lt; 0.001). Our novel score outperformed the performance of the 2010 TFC using those parameters, which are available in routine clinical practice (AUC95%,p &lt; 0.001(95%CI.91-.99)vs.AUC90%,p &lt; 0.001(95%CI.84-.97). A score value of 7/12 points yielded a specificity of 98% and a sensitivity of 61% for a diagnosis of ARVC. Conclusions ARVC patients present with significantly larger RA as compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete´s heart. Abstract Figure. Novel clinical score

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