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J Am Coll Cardiol, 2002; 40:1856-1863
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CARDIAC MAGNETIC RESONANCE STUDIES

Athlete’s heart

Right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging

J.ürgen Scharhag, MD*,*, G.ünther Schneider, MD{dagger}, Axel Urhausen, MD*, Veneta Rochette*, Bernhard Kramann, MD{dagger} and Wilfried Kindermann, MD*

* Institute of Sports and Preventive Medicine, Saarbrücken, Germany
{dagger} Clinic of Radiology, Department of Radiodiagnostics, University of Saarland, Saarbrücken, Germany

Manuscript received March 13, 2002; revised manuscript received June 13, 2002, accepted July 17, 2002.

* Reprint requests and correspondence: Dr. Jürgen Scharhag, Institute of Sports and Preventive Medicine, University of Saarland, campus, Building 39.1, 66123 Saarbrücken, Germany.
j.scharhag{at}mx.uni-saarland.de

OBJECTIVES: Athlete’s heart represents a structural and functional adaptation to regular endurance exercise.

BACKGROUND: While left ventricular (LV) hypertrophy of the athlete’s heart has been examined in many studies, the extent of right ventricular (RV) hypertrophy is still uncertain because of its complex shape and trabecular structure. To examine RV hypertrophy, we used magnetic resonance imaging (MRI) and hypothesized that athlete’s heart is characterized by similar LV and RV hypertrophy.

METHODS: The LV and RV mass, volume, and function in 21 male endurance athletes (A) (27 ± 4 years; 70 ± 8 kg; 178 ± 7 cm; maximal oxygen uptake [VO2max]: 68 ± 5 ml/min per kg) and 21 pair-matched untrained control subjects (C) (26 ± 3 years; 71 ± 9 kg; 178 ± 6 cm; VO2max: 42 ± 6 ml/min per kg) were analyzed by MRI (Magnetom Vision 1.5T, Siemens, Erlangen, Germany).

RESULTS: Left ventricular masses (A: 200 ± 20 g; C: 148 ± 17 g) and RV masses (A: 77 ± 10 g; C: 56 ± 8 g) differed significantly between the groups (p < 0.001). The LV and RV end-diastolic volumes (EDV) (LV-EDV 167 ± 28 ml [A]; 125 ± 16 ml [C]; RV-EDV 160 ± 26 ml [A]; 128 ± 10 ml [C]), and stroke volumes (SV) (LV-SV: 99 ± 18 ml [A], 74 ± 11 ml [C]; RV-SV: 102 ± 18 ml [A], 79 ± 8 ml [C]) were significantly different between the athletes and control subjects (p < 0.001), whereas ejection fractions (EF) (LV-EF: 59 ± 3% [A]; 59 ± 6% [C]; RV-EF: 63 ± 3% [A], 62 ± 3% [C]) and LV-to-RV ratios were similar for both groups (LV-to-RV mass: 2.6 ± 0.2 [A], 2.6 ± 0.3 [C]; LV-to-RV EDV: 1.05 ± 0.14 [A], 0.99 ± 0.14 [C]; LV-to-RV SV: 0.98 ± 0.17 [A], 0.95 ± 0.17 [C]; LV-to-RV EF: 0.93 ± 0.07 [A], 0.96 ± 0.10 [C]).

CONCLUSIONS: Regular and extensive endurance training results in similar changes in LV and RV mass, volume, and function in endurance athletes. This leads to the conclusion that the athlete’s heart is a balanced enlarged heart.

Abbreviations and Acronyms
  BSA
  body surface area
  EDD
  end-diastolic diameter
  EDV
  end-diastolic volume
  EF
  ejection fraction
  ESV
  end-systolic volume
  LV
  left ventricle/ventricular
  MRI
  magnetic resonance imaging
  RV
  right ventricle/ventricular
  SV
  stroke volume
  VO2max
  maximal oxygen uptake




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