P635Prominent contribution of free wall to supernormal right ventricular contractility of competitive athletes: a speckle tracking and real-time three-dimensional echocardiography

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Purpose: To assess determinants of supernormal right ventricular (RV) contractility in competitive athletes by combining real-time 3-D echo (RT3DE) and Speckle Tracking Echocardiography (STE).Methods: RV function was compared in 43 healthy controls and 40 top-level rowers by standard echo-Doppler, RT3DE and STE. RV internal diameters, tricuspid annular plane systolic excursion (TAPSE), tricuspid inflow E/A ratio and pulsed Tissue Doppler of lateral tricuspid annulus were determined. RT3DE RV volumes were estimated off-line and both ejection fraction (EF) and stroke volume (SV) derived. STE provided estimate of RV global longitudinal strain (GLS) (6 segments), septal longitudinal strain (average of 3 septal regions, SLS) and lateral longitudinal strain (average of 3 lateral regions, LLS).Results: The 2 groups were comparable for age, body mass index and blood pressure while heart rate (HR) was lower in rowers (p<0.0001). RV diameters were significantly larger and TAPSE, E/A ratio, and Tissue Doppler derived s' and e' velocities higher in rowers. RT3DE RV end-diastolic volume (EDV) and end-systolic volume were greater in rowers (both p<0.0001), without differences of EF. STE derived GLS (p<0.005) and LLS (p<0.001), but not SLS, were higher in rowers. In the pooled population LLS was related to EDV (r = 0.42) (Figure) and SV (r = 0.39) (both p<0.0001). Both these relations remained significant after adjusting for HR (r = 0.35, p<0.001 and r = 0.33, p<0.002 respectively).Conclusions: The combination of RT3DE and STE allows to increase the knowledge of RV contractility in athletes. By the Frank-Starling mechanism the preload increase (EDV) exerts its maximal influence on the longitudinal lateral fibers, whose effect induces in its turn the increase of SV.

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