Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes

To investigate the physiological adaptation of the right ventricle (RV) in response to endurance training and to define reference values for regional deformation in the RV in endurance athletes. Healthy controls (n = 61), athletes (n = 58), and elite athletes (n = 63) were prospectively enrolled with a training intensity of 2.2 +/- 1.6, 12.5 +/- 2.3 and 24.2 +/- 5.7 h/week, respectively (P < 0.001). Conventional echocardiographic parameters, tissue Doppler imaging (TDI), and 2D strain echo (2DSE)-derived velocity, strain, and strain rate (SR) were calculated in three RV segments. Left ventricular and RV dimensions were significantly increased (P < 0.001) in both groups of athletes compared with controls. Right ventricular systolic velocities and displacement were not different between the groups. Right ventricular strain and SR values were reduced in the RV basal and mid-segment in athletes. Athletes with marked RV dilatation showed lower strain and SR values in the basal (-20.9 +/- 4.7 vs. -24.5 +/- 4.9%, P < 0.001 and -1.23 +/- 0.31 vs. -1.50 +/- 0.33 s(-1), P < 0.001) and mid (-29.3 +/- 5.4 vs. -32.1 +/- 5.3%, P = 0.017 and -1.58 +/- 0.41 vs. -1.82 +/- 0.42 s(-1), P = 0.009) segment, whereas athletes without RV dilatation showed no significant difference compared with the controls. Regional deformation and deformation rates (TDI and 2DSE) are reduced in the basal RV segment in athletes. This phenomenon is most pronounced in athletes with RV dilatation and should be interpreted as normal when evaluating athletes suspected for RV pathology.