Author + information
- Received May 30, 2018
- Revision received August 27, 2018
- Accepted September 18, 2018
- Published online September 2, 2019.
- Flavio D’Ascenzi, MD, PhDa,∗ (, )
- Francesca Anselmi, MDa,
- Pietro Piu, PhDb,
- Caterina Fiorentini, MDa,
- Salvatore Francesco Carbone, MDc,
- Luca Volterrani, MDc,
- Marta Focardi, MD, PhDa,
- Marco Bonifazi, MDb and
- Sergio Mondillo, MDa
- aDepartment of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- bDepartment of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
- cUnit of Diagnostic Imaging, University Hospital Santa Maria alle Scotte, Siena, Italy
- ↵∗Address for correspondence:
Dr. Flavio D’Ascenzi, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16 53100 Siena, Italy.
Objectives The aim of this meta-analysis was to derive normal reference values of biventricular size and function estimated by cardiac magnetic resonance (CMR) in competitive athletes.
Background Exercise-induced enlargement of cardiac chambers is commonly observed in competitive athletes. However, ventricular dilatation is also a common phenotypic expression of life-threatening cardiomyopathies. The use of CMR for the exclusion of pathology is growing. However, normal reference values have not been established for athletes.
Methods The authors conducted a systematic review of English-language studies in the MEDLINE, Scopus, and Cochrane databases investigating biventricular size and function by CMR in athletes. Athletes were divided into endurance, combined, and mixed groups according to the sport practiced. The potential impact of training volume was also evaluated.
Results Twenty-seven studies and 983 competitive athletes were included for CMR quantification of biventricular size and function. In this review, normal reference values are presented for biventricular size and function to be applied to male competitive athletes according to the disciplines practiced. A significant impact of training volume was demonstrated for the right ventricle: athletes practicing the largest number of training hours per week were those exhibiting the greatest degree of right ventricular remodeling. Notably, biventricular function was not significantly affected by training volume.
Conclusions The present meta-analysis defines the normal limits of biventricular size and function estimated by CMR in competitive athletes. The authors suggest using these normal reference values as an alternative to standard upper limits derived from the general population when interpreting CMR images in athletes.
- chamber quantification
- left ventricle
- right ventricle
- systematic review
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 30, 2018.
- Revision received August 27, 2018.
- Accepted September 18, 2018.
- 2019 American College of Cardiology Foundation
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