26
1.2 Chronic Changes in Right Ventricle in the Long Term
Exercise
RV adaptations are more evident in endurance exercise that determines an eccentric
remodelling. RV dimensions appear greater in endurance athletes of high categories
than in strength athletes and sedentary controls when analyzed after a long term
training. RV free walls appear thicker in endurance athletes (normal value of RV
free wall thickness is inferior to 0.5 cm, measured with echocardiography from the
sub-costal or parasternal long axis view). The inferior vena cava is larger (average
value 26 mm, upper value 40 mm) but with a normal collapsibility in inspiration [ 2 ].
In a recent meta-analysis study, it has been demonstrated a positive and significant
correlation between body surface area (BSA) and RV parameters. For this reason, it
is necessary to index RV parameters for BSA in athletes [ 21 ].
Using monodimensional or bidimensional mode 2D imaging, the thicknessshould be measured at end-diastole at the level of tricuspid valve chords, excluding
the thickness of the papillary muscle. Other necessary measures to evaluate the RV
enlargement are the RV basal diameter (RVD1), RV medium-ventricular diameter
(RVD2) and RV base-apex diameter (RVD3) in apical four chamber view. A recent
experts consensus on echocardiography on athlete’s heart have proposed some
range values for RV in athletes [ 2 ] (Table 2.1). Several cohort studies have demon-
strated augmented systolic function in athletes using the TAPSE as a measure of
global RV function [ 22 ]. However, a large study recently showed that echocardio-
graphic systolic parameters of RV systolic function were slightly reduced in athletes
at rest compared to nonathletic controls. This reduction was more pronounced in
those with more evident RV dilatation. D’Andrea et al. have evaluated the RV sys-
tolic function in 430 athletes by using both 2D and 3D echocardiography. They have
demonstrated that all 2D RV diameters and 3D volumes were higher in endurance
Table 2.1 Upper range for cardiac ventricles dimension in athletes [ 48 ]
RVD1(mm) RVOT (mm) LVEDD (mm) LVWT (mm)
Caucasian adult
Male 55 43 63 12
Female 49 40 56 11
Caucasian adolescent (14–18 years)
Male – – 58 12
Female – – 54 11
Black adult
Male 55 43 62 15
Female 49 40 56 12
Black adolescent (14–18 years)
Male – – 62 15
Female – – 56 11LVEDD left ventricular end diastolic diameter, LVWT left ventricular wall thickness, RVD1 basal
right ventricular diameter, RVOT right ventricular outflow tract
A. D’Andrea et al.