Endurance sport activity may increase right heart size for teen athletes
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Key takeaways:
- Teen soccer players had increased right ventricular parameters that exceeded reference ranges but were comparable with adult players.
- No teens were diagnosed with cardiomyopathy after clinical assessments.
Echocardiographic data show that physiological adaptation due to sporting activity can cause increased right heart size for adolescent boys, researchers reported.
The study, published in Echo Research & Practice, demonstrated that right ventricular dimensions for a cohort of teenage U.K. academy soccer players were larger than joint reference ranges for adults published by the American and European societies of echocardiography, Aneil Malhotra, PhD, MB, BChir, MA, MRCP, MSc, presidential fellow and senior lecturer at the University of Manchester and honorary consultant cardiologist in inherited cardiac conditions, cardiac MRI and sports cardiology at Wythenshawe and Manchester Royal Infirmary Hospitals, and colleagues wrote. Up to 59% of certain measurements exceeded those of normal adult ranges, the researchers wrote.
“Historically, the left ventricle in athletes has been characterized in detail with studies demonstrating how physiological adaptation to exercise may be influenced in adolescents and adults by ethnicity, sporting discipline and gender,” Malhotra and colleagues wrote. “By contrast, there are fewer studies detailing physiological adaptation to exercise in the right ventricle. Furthermore, the majority of these studies detail the impact of physiological changes in adults as opposed to characterizing RV geometric changes of the adolescent athlete (aged 13 to 18 years). There are even fewer studies discussing the potential impact of ethnicity on RV adaptation to exercise.”
Malhotra and colleagues analyzed ECG and echocardiographic data from 1,087 adolescent boys aged 13 to 18 years (mean age, 16 years) who played academy football and attended mandatory cardiac screenings. Athletes underwent assessment with a health questionnaire, physical examination, 12-lead ECG and echocardiography. Within the cohort, 76% of boys were white; 15% were Black and 9% identified as mixed race. For age group comparison of the RV, researchers collected similar data for 114 adult male soccer players (mean age, 21 years). Training time (hours per week) was similar between both academy and adult groups.
Among the academy players, none reported any cardiac symptoms suggestive of underlying cardiac pathology or any family history of cardiomyopathy or sudden cardiac death.
The researchers observed arrhythmogenic RV cardiomyopathy major criteria for T-wave inversion in 3.3% of the academy footballer cohort, with the finding more prevalent among adolescent Black athletes (12%) vs. mixed race athletes (6.3%) or white athletes (1%; P < .05).
Assessing absolute RV dimensions, the researchers found that parameters in the academy cohort exceeded those published in joint American and European guidance by 5% to 59%; however, the values were similar to those seen in the adult players. There were no race-based differences in RV dimensions.
RV outflow tract diameter measurements fulfilled major criteria for arrhythmogenic RV cardiomyopathy for 12% of the teen soccer players, according to the researchers. Overall, 0.2% of the cohort fulfilled diagnostic criteria for “definite” arrhythmogenic RV cardiomyopathy and 2.2% fulfilled diagnostic criteria for “borderline” arrhythmogenic RV cardiomyopathy for RV dimensions and ECG changes. This was observed more frequently in Black participants (9.9%) compared with those who were mixed race (3.9%) or white (0.6%; P < .05).
Among athletes meeting “definite” or “borderline” arrhythmogenic RV cardiomyopathy criteria, no cardiomyopathy was identified after a comprehensive clinical assessment, which included cardiac MRI, exercise testing, ambulatory ECGs and familial evaluation.
The researchers noted that the findings could not be extrapolated to female athletes and that the data were from a single point in time and not longitudinal in nature.
“Right heart sizes in excess of some standard adult ranges occur frequently in academy footballers and are similar to those seen in adult footballers,” the researchers wrote. “It is not unusual to observe values that would overlap with criteria for arrhythmogenic RV cardiomyopathy. There was no inter-ethnic variability for RV dimensions identified. This work will be of value to those undertaking RV assessment in similar sporting participants.”
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