Background: The significance and spectrum of reduced right ventricular (RV) deformation, reported in endurance athletes, is unclear. Purpose: to comprehensively analyze the cardiac performance at rest of athletes, especially focusing on integrating RV size and deformation to unravel the underlying triggers of this ventricular remodelling. Methods: 100 professional male athletes and 50 sedentary healthy males of similar age were prospectively studied. Conventional echocardiographic parameters of all 4 chambers were obtained, as well as 2D echo-derived strain (2DSE) in the left (LV) and in the RV free wall with separate additional analysis of the RV basal and apical segments. Results: Left and right-sided dimensions were larger in athletes than in controls, but with a disproportionate RA enlargement. RV global strain was lower in sportsmen (-26.8 ± 2.8 vs -28.5 ± 3.4%, p<0.001) due to a decrease in the basal segment (-22.8 ± 3.5 vs -25.8 ± 4.0%, p<0.001) resulting in a marked gradient of deformation from the RV inlet towards the apex. By integrating size, deformation and stroke volume, we observed that the LV working conditions were similar in all sportsmen while a wider variability existed in the RV. Conclusions: Cardiac remodelling in athletes is more pronounced in the right heart cavities with specific regional differences within the right ventricle, but with a wide variability among individuals. The large inter-individual differences, as well as its acute and chronic relevance warrant further investigation.

This work was partially funded by grants from the Fundació Clinic (premio Emili Letang, B. Merino), Generalitat de Catalunya (FI-AGAUR 2014-2017 (RH 040991, M. Sanz), and from the Spanish Society of Cardiology (Fundación Española del Corazón Investigación Clínica 2012), the Spanish Government (Plan Nacional I+D+i, Ministerio de Innovación y Ciencia DEP 2011-2013 (DEP 2010-20565); Intensificación Actividad Investigadora, Instituto de Salud Carlos III (M Sitges; PI11/01709); Plan Nacional I+D, Ministerio de Economia y Competitividad DEP2013-44923-P, TIN2014-52923-R and FEDER.