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or incomplete RBBB can be considered an adaptation finding of the athlete’s heart
if other pathological signs are absent. Inparticular the presence of T-Wave inversion
in V1, V2 and V3 and Epsilon wave, which make the suspicion for ARVC.
1 Right Heart and Pulmonary Circulation
During exercise, the increased cardiac output of the LV determines an augmented
venous return to the right chambers, which progressively enlarge during the physi-
cal exercise more than the LV to adequately collect the venous return. The enlarge-
ment of the RV developes during the endurance exercise. Also the diastolic function
change, in fact it is demonstrated an increased atrial component of the pattern of
flow across the tricuspid valve [ 7 ]. This volume overload determine both RA and
RV dilatation and increased wall thickness. It has been described greater RV inflow
and outflow dimension in the athlete’s heart compared to sedentary controls, with a
normal systolic function expressed by tricuspid annular plane systolic excursion
(TAPSE) [ 7 ]. Moreover, the higher the level of trained athletes and most obvious is
the heart adaptation. Baggish et al. studied a population of 40 athletes: 20 Olympic
rowers and 20 university level rowers. Olympic athletes shown greater RV end-
diastolic chamber dimensions and, at the same time an improvement of both sys-
tolic and late diastolic relaxation examined by color tissue Doppler (TDI) and strain
analysis [ 8 ]. Recently, D’Andrea et al. described the distribution of dimensions of
RV (and also the RA) in a group of athletes and the impact of the type of long-
training on these variables. They observed an increased of the cavitary dimensions
with higher RV sphericity index in endurance athletes [ 9 ]. Enlargement of RV
dimension is associated with an improved diastolic function, with a normal systolic
function. Moreover, in the “athlete’s heart” the LV stroke volume and pulmonary
artery systolic pressure (PASP) are predictors of RV dimensions, demonstrating that
there is a high interdependence of the two ventricles. The alternative method to
evaluate the RV is the cardiac magnetic resonance (CMR) expecially for athletes
who have a poor acoustic window. This diagnostic tool has a high spatial and tem-
poral resolution. It is accurate for measuring the wall thickness and for the tissue
characterization, that is very important to differentiate the physiological enlarge-
ment of the athlete’s heart from pathological conditions as ARVC [ 2 ].
1.1 Acute Changes in Right Ventricle in the Post Exercise
Phase
The effects of physical exercise on the RV are just evident in the acute phase post-
exercise. Right ventricle is the first chamber to show the adaptation of the athlete’s
heart to exercise expecially in the phase post-exercise during endurance training.
A. D’Andrea et al.