Analysis of Regional Right Ventricular Function by Tissue Doppler Imaging and Three-Dimensional Echocardiography in Highly Trained Athletes

BACKGROUND: Regional right ventricular (RV) function has not yet been characterized in highly trained athletes, and the effects of increased RV volumes on resting changes of regional RV deformation are unknown. PURPOSE: The aim of the study was to analyze global and regional RV function by a multisegmental approach using tissue Doppler imaging (TDI) and to determine whether higher RV volumes evaluated by three-dimensional echocardiography (3DE) had an impact on the RV mechanics assessed by resting regional TDI parameters. METHODS: We enrolled prospectively 25 professional soccer players and 25 age- and sex-matched nonathletic controls. Transthoracic echocardiography including additional views of the RV was performed. The TDI sample volume was placed in the basal region of the anterior, inferior, and RV free wall to assess the following parameters: isovolumic contraction time (IVCT(RV)), isovolumic relaxation time (IVRT(RV)), ejection time (ET(RV)), and myocardial performance index (MPI(RV)). Furthermore, conventional left ventricular (LV) and RV parameters at two-dimensional (2D) and 3DE were determined. RESULTS: In athletes, LV mass index/body surface area (BSA), left atrial volume index, 2D LV volumes/BSA were significantly increased in comparison with controls. Moreover, athletes had higher 2D LV and RV stroke volume (SV), lower values for A wave and E/e' ratio, higher basal RV diameter, and right atrial (RA) area (P < 0.0001). Moreover, athletes showed significantly increased LV and RV volumes and SV indexed for BSA (P < 0.0001) evaluated at 3DE. In athletes, ET(RV-free wall), ET(RV-anterior), IVCT(RV-inferior), and IVCT(RV-anterior) were statistically increased (P < 0.0001). Conversely, IVRT(RV-anterior) was reduced in comparison with controls. A significant positive correlation between IVRT(RV-inferior) and three-dimensional (3D) RV end-diastolic volume (EDV), end-systolic volume, and SV was observed in athletes. Finally, a good positive correlation was observed between 3D RV EDV and 3D LV SV indexed for BSA. CONCLUSIONS: In athletes, the higher 3D RV volumes are proportionally related to an increase of IVRT(RV-inferior) and 3D LV SV. Further studies on the resting changes of regional RV deformation for screening and follow-up in these participants are needed.