Physiologic Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin
Background—Regular, intensive exercise results in physiologic biventricular cardiac adaptation. Ethnicity is an established determinant of left ventricular (LV) remodelling; black athletes (BA) exhibit more profound LV hypertrophy than white athletes (WA). Right ventricular (RV) remodelling has not been characterized in BA, although the issue is pertinent since BA commonly exhibit electrocardiographic anomalies resembling arrhythmogenic right ventricular cardiomyopathy (ARVC).
Methods and Results—Between 2006-2012, 300 consecutive BA (n=243 male) from 25 sporting disciplines were evaluated using ECG and echocardiography. Results were compared with 375 WA and 153 sedentary controls (n=69 black). There were no ethnic differences between RV parameters in controls. Both BA and WA exhibited greater RV dimensions than controls. Right ventricular dimensions were marginally smaller in BA compared with WA (outflow [RVOT1], 30.9±5.5 vs. 32.8±5.3mm, p<0.001; base-apex, 86.6±9.5 vs. 89.8±9.6mm, p<0.001), although only 2.3% of variation was attributable to ethnicity. Right ventricular enlargement compatible with diagnostic criteria for ARVC was frequently observed (RVOT1≥32mm; 45.0% BA, 58.5% WA). Anterior T-wave inversion was present in 14.3% BA vs. 3.7% WA (p<0.001). Marked RV enlargement with concomitant anterior T-wave inversion was observed in 3.0% BA vs. 0.3% WA (p=0.005). Further investigation did not diagnose ARVC in any athlete.
Conclusions—Physiologic RV enlargement is commonly observed in black as well as white athletes. The impact of ethnicity is minimal, obviating the need for race-specific RV reference values. However, in the context of frequent electrocardiographic repolarization anomalies in BA, the potential for erroneous diagnosis of ARVC is considerably greater in this ethnic group.
- Received December 6, 2012.
- Revision received February 14, 2013.
- Accepted March 4, 2013.