P3989Normative reference values for the right ventricle in competitive athletes

Abstract

Background: Training-induced right ventricular (RV) enlargement is frequent in athletes. Unfortunately, RV dilatation is also a common phenotypic expression and one of the diagnostic criteria of arrhythmogenic RV cardiomyopathy (ARVC). The current echocardiographic reference values derived from the general population can overestimate the presence of RV dilatation and/or dysfunction in competitive athletes. Purpose: We performed a meta-analysis of the literature to derive the proper reference values for assessing RV enlargement in competitive athletes. Methods: We conducted systematic review of English-language studies in MEDLINE, Scopus, and Cochraine databases from inception to April 2016, investigating the RV by echocardiography in competitive athletes. Results: 7,287 competitive athletes were included in the final analysis. The mean value of RV echocardiographic parameters was reported both for male and female athletes. Reference values for RV functional and dimensional parameters were established for male athletes and reported separately when age and type of sports significantly had an impact. Male competitive athletes exhibited a marked RV remodelling with the upper limits of normality being greater than those recommended for the general population, particularly for absolute dimensional parameters. The upper limits of RV outflow tract (RVOT) indexes (RVOT PLAX 18 mm/m2; RVOT PSAX 22 mm/m2) and the lower limit of RV fractional area change (38% for athletes under 30-years-old and 33% for athletes over 30-years -old) were similar to those recommended by current Task Force as major diagnostic criteria for ARVC. The lower limit of RV strain was similar to that recommended for the general population, i.e. -21%. Conclusions: Physicians should be aware that application of the current recommendations for normal population could be misleading when evaluating athletes. In this meta-analysis we derive normative values for RV echocardiographic examination to be applied in competitive athletes exhibiting RV remodelling. We suggest using these normative reference values to avoid the overestimation of RV abnormal size or function in this specific population.