endurance running nonsense

European Heart Journal 28:183-9
Reduced right ventricular ejection fraction in endurance athletes presenting
with ventricular arrhythmias: a quantitative angiographic assessment
Joris Ector, Javier Ganame, Nico van der Merwe, Bert Adriaenssens, Laurent
Pison, Rik Willems, Marc Gewillig & Hein Heidbüchel 2007
hein.heidbuchel@xxxxxxxxxxxxxxxxx
Aims:
Spontaneous or inducible sustained ventricular arrhythmias (VA) in endurance
athletes frequently originate from the right ventricle (RV), even in the
absence of familial arrhythmogenic RV cardiomyopathy (ARVC). The goal of
this study was to determine whether the RV arrhythmogenic predilection in
these patients is associated with RV functional abnormalities.
Methods and results:
Biplane RV angiography was performed in three groups: 22 endurance athletes
with VA, 15 matched athletes without VA, and 10 non-athletes without VA.
Four methods for quantitative RV angiographic analysis (area length, Boak,
pyramid monoplane, and pyramid biplane) were used to calculate RV
end-diastolic volume (EDV) and end-systolic volume (ESV) (both corrected for
body surface area) and ejection fraction (EF). In addition RV outflow tract
shortening fraction (SF) was determined. Although only 6 of 22 (27%)
athletes with VA fulfilled the diagnostic criteria for ARVC, RV
arrhythmogenic involvement was manifest or probable in 82%, based on a
combination of electrophysiologic, electrocardiographic, and morphologic
criteria. RV EDV in athletes was higher than in non-athletes (area length:
100.3 ± 26.9 vs. 69.6 ± 14.3 mL/m2, P = 0.001), without significant
difference between athletes with and without VA. RV ESV, in contrast, was
significantly higher in athletes with VA than in athletes without VA (52.6 ±
22.3 vs. 35.5 ± 11.2 mL/m2, P = 0.004), resulting in a significantly lower
RV EF, a consistent finding across all methods (area length: 49.1 ± 10.4 vs.
63.7 ± 6.4%, P < 0.001). This functional impairment was also reflected in a
lower RV outflow tract SF (SF right anterior oblique 32.2 ± 10.1 vs. 40.0 ±
11.6%, P = 0.09; SF left anterior oblique (LAO) 31.9 ± 7.8 vs. 39.0 ± 10.5%,
P = 0.10).
Conclusion:
VA in high-level endurance athletes frequently originate from a mildly
dysfunctional RV. This raises the question whether endurance exercise not
only acts as a trigger for these arrhythmias but also as promoter of the RV
changes.


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