Disproportionate exercise load and remodeling of the athlete's right ventricle
Abstract
Purpose There is evolving evidence that intense exercise may place a disproportionate load on the right ventricle (RV) when compared with the left ventricle (LV) of the heart. Using a novel method of estimating end-systolic wall stress (ES-σ), we compared the RV and LV during exercise and assessed whether this influenced chronic ventricular remodeling in athletes. Methods For this study, 39 endurance athletes (EA) and 14 nonathletes (NA) underwent resting cardiac magnetic resonance (CMR), maximal oxygen uptake (VO2), and exercise echocardiography studies. LV and RV end-systolic wall stress (ES-σ) were calculated using the Laplace relation (ES-σ = Pr/(2h)). Ventricular size and wall thickness were determined by CMR; invasive and Doppler echo estimates were used to measure systemic and pulmonary ventricular pressures, respectively; and stroke volume was quantified by Doppler echocardiography and used to calculate changes in ventricular geometry during exercise. Results In EA, compared with NA, resting CMR measures showed greater RV than LV remodeling. The ratios RV ESV/LV ESV (1.40 ± 0.23 vs 1.26 ± 0.12, P = 0.007) and RV mass/LV mass (0.29 ± 0.04 vs 0.25 ± 0.03, P = 0.012) were greater in EA than in NA. RVES-σ was lower at rest than LVES-σ (143 ± 44 vs 252 ± 49 kdyn · cm, P Conclusions Exercise induces a relative increase in RVES-σ which exceeds LVES-σ. In athletes, greater RV enlargement and greater wall thickening may be a product of this disproportionate load excess.
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Ventricular load increases with exercise intensity and is greater for the right ventricle than the left ventricle.
“It has been demonstrated that ventricular load increases with exercise intensity and is greater for the RV than the LV, 29”
From Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes (2012) · cites this paper as [29]
Trained athletes during intense exercise demonstrate considerable increases in pulmonary pressures.
“The considerable increases in pulmonary pressures demonstrated in trained athletes during intense exercise 29,30,34 suggest a similar physiological stress, albeit only transient.”
From Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes (2012) · cites this paper as [29]
During maximal exercise of short duration, the RV is placed under greater haemodynamic stress than the LV.
“During maximal exercise of short duration, we have previously demonstrated that the RV is placed under greater haemodynamic stress than the LV 29”
From Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes (2012) · cites this paper as [29]
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- Authors
- LA GERCHE, A., HEIDBÜCHEL, H., BURNS, A. T., MOONEY, D. J., TAYLOR, A. J., PFLUGER, H. B., INDER, W. J., MACISAAC, A. I., & PRIOR, D. L.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- St Vincent's Hospital Melbourne (AU)
- Baker Heart and Diabetes Institute (AU)
- The University of Melbourne (AU)
- ORCID
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2011-06
- Volume
- 43
- Issue
- 6
- Pages
- 974-981
- ISSN
- 0195-9131 (ISSN-L)
- OpenAlex
- W1976805840
- Cited by
- 347
- References
- 42
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 14 · 2023: 11 · 2022: 28 · 2021: 25 · 2020: 36 · 2019: 22 · 2018: 36 · 2017: 27 · 2016: 23 · 2015: 33 · 2014: 24 · 2013: 16 · 2012: 19
- FWCI
- 9.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Keywords
- right ventricular remodeling, endurance athletes, end-systolic wall stress, exercise-induced cardiac remodeling, right ventricle, left ventricle, pulmonary hypertension, training load, cardiac magnetic resonance, exercise echocardiography, pulmonary artery pressure, right ventricular mass, wall thickening, Laplace law, athlete's heart
- MeSH terms
- Adult, Physical Exertion, Female, Heart Ventricles, Humans, Male, Oxygen Consumption, Stroke Volume, Systole, Exercise, Case-Control Studies, Ventricular Function, Left, Ventricular Function, Right, Ultrasonography, Doppler, Magnetic Resonance Imaging, Cine, Ventricular Remodeling, Athletes
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