St George's University of London, Division of Cardiac and Vascular Sciences, London, United Kingdom
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Purpose: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is the cause of sudden death in a significant proportion of young athletes, particularly in the Mediterranean region. Several studies have demonstrated right ventricular (RV) enlargement as a result of systematic training. The use of transthoracic echo (TTE) to differentiate ARVC from physiological RV enlargement is an essential component of cardiovascular assessment in athletes. International criteria for RV quantification are derived from studies of non-athletes, lack indexing for body surface area (BSA), and do not distinguish between male and female subjects. We aim to establish TTE RV upper reference limits (URLs) for male elite athletes (EA), with indexing for BSA.Methods: TTE was performed in 167 healthy, male EA after prior evaluation of personal and family history, and 12-lead ECG. EA from 11 different sporting disciplines were included (73% competing at international level). Mean age was 21.8 years. Five standard RV measurements were made in each case, and compared with ESC reference values. Proposed URLs for EA were calculated as (mean + 2 standard deviations of the mean), and indexed for BSA.Results: Image quality was sufficient for a total of 712 RV measurements: 72% of these exceeded ESC URLs (Table 1). Mean values for all 5 RV dimensions in EA were greater than ESC URLs.Conclusions: RV dimensions in male EA are considerably greater than current ESC reference values for the general population, which should not be used as markers of pathology in athletes. We propose novel, BSA-indexed URLs for RV dimensions in male EA, and advocate similar studies in female athletes.