Normative Reference Values of Right Heart in Competitive Athletes: A Systematic Review and Meta-Analysis

      Highlights

      • The RV of competitive athletes is often enlarged when applying the current cutoffs.
      • The current recommendations for the general population cannot be applied to athletes.
      • In this study, normative reference values were obtained in competitive athletes.
      • Athletes engaged in combined sports exhibit the greatest degree of RV remodeling.
      • RV function can be slightly reduced at rest in healthy competitive athletes.
      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 in athletes. We performed a meta-analysis of the literature to derive the proper reference values for assessing RV enlargement in competitive athletes. We conducted systematic review of English-language studies in the MEDLINE, Scopus, and Cochrane databases investigating RV size and function by echocardiography and by cardiac magnetic resonance (CMR) in competitive athletes. In total, 6,806 and 740 competitive athletes were included for the echocardiographic and CMR quantification of the RV, respectively. In this review, we present normal reference values for RV size and function to be applied in competitive athletes according to the disciplines practiced. The reference ranges reported in this review suggest that physicians should be aware that application of the current recommendations for normal population could be misleading when evaluating athletes. We suggest using these normative reference values, obtained in competitive athletes, to avoid the potential for mistakenly concluding, in this specific population, that RV size or function are abnormal.

      Keywords

      Abbreviations:

      ARVC (Arrhythmogenic right ventricular cardiomyopathy), BIC (Bayesian information criterion), BSA (Body surface area), CMR (Cardiac magnetic resonance), FAC (Fractional area change), LV (Left ventricular), PLAX (Parasternal long-axis view), PSAX (Parasternal short-axis view), RA (Right atrial), RV (Right ventricular, ventricle), RVOT (Right ventricular outflow tract), TAPSE (Tricuspid annular plane systolic excursion), TF (Task force)
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