Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (T.G.D., B.A.C., M.S.).
Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.).
Circ Cardiovasc Imaging. 2021 May;14(5):e012315. doi: 10.1161/CIRCIMAGING.120.012315. Epub 2021 May 17.
Structural remodeling of the right ventricle (RV) is widely documented in athletes. However, functional adaptation, including RV pressure generation and systolic free-wall longitudinal mechanics, remains equivocal. This meta-analysis compared RV pressure and function in athletes and controls.
A systematic review of online databases was conducted up to June 4, 2020. Meta-analyses were performed on RV systolic pressures, at rest and during exercise, tricuspid annular plane systolic displacement, myocardial velocity (S'), and global and regional longitudinal strain. Bias was assessed using Egger regression for asymmetry. Data were analyzed using random-effects models with weighted mean difference and 95% CI.
Fifty-three studies were eligible for inclusion. RV systolic pressure was obtained from 21 studies at rest (=1043:1651; controls:athletes) and 8 studies during exercise (=240:495) and was significantly greater in athletes at rest (weighted mean difference, 2.9 mmHg [CI, 1.3-4.5 mmHg]; =0.0005) and during exercise (11.0 [6.5-15.6 mm Hg]; <0.0001) versus controls. Resting tricuspid annular plane systolic displacement (<0.0001) and S' (=0.001) were greater in athletes. In contrast, athletes had similar RV free-wall longitudinal strain (17 studies; =450:605), compared with controls but showed greater longitudinal apical strain (16 studies; =455:669; 0.9%, 0.1%-1.8%; =0.03) and lower basal strain (-2.5% [-1.4 to -3.5%]; <0.0001).
Functional RV adaptation, characterized by increased tricuspid annular displacement and velocity and a greater base-to-apex strain gradient, is a normal feature of the athlete's heart, together with a slightly elevated RV systolic pressure. These findings contribute to our understanding of RV in athletes and highlight the importance of considering RV function in combination with structure in the clinical interpretation of the athlete's heart.
右心室（RV）的结构重塑在运动员中被广泛记录。然而，包括 RV 压力产生和收缩游离壁纵向力学在内的功能适应仍然存在争议。本荟萃分析比较了运动员和对照组的 RV 压力和功能。
对在线数据库进行了系统检索，检索截止日期为 2020 年 6 月 4 日。对 RV 收缩压、静息和运动时三尖瓣环平面收缩位移、心肌速度（S'）以及整体和局部纵向应变进行荟萃分析。使用 Egger 回归评估偏倚的不对称性。使用随机效应模型分析数据，采用加权均数差和 95%置信区间。
53 项研究符合纳入标准。21 项研究在静息时获得 RV 收缩压（=1043：1651；对照组：运动员），8 项研究在运动时获得 RV 收缩压（=240：495），运动员在静息时（加权均数差，2.9mmHg[CI，1.3-4.5mmHg]；=0.0005）和运动时（11.0[6.5-15.6mmHg]；<0.0001）的收缩压显著高于对照组。运动员的三尖瓣环平面收缩位移（<0.0001）和 S'（=0.001）较大。相比之下，运动员的 RV 游离壁纵向应变（17 项研究；=450：605）与对照组相似，但显示出更大的纵向心尖应变（16 项研究；=455：669；0.9%，0.1%-1.8%；=0.03）和较低的基底应变（-2.5%[-1.4 至-3.5%]；<0.0001）。
RV 功能适应的特征是三尖瓣位移和速度增加，以及基底至心尖应变梯度增大，这是运动员心脏的正常特征，同时 RV 收缩压略有升高。这些发现有助于我们了解运动员的 RV，并强调在临床解释运动员心脏时，将 RV 功能与结构结合起来的重要性。
