Influence of isometric versus isotonic exercise training on right ventricular morpho-functional parameters in olympic athletes

Background: Cardiovascular adaptations in elite athletes involve both ventricular and atrial changes. Nowadays, limited research exists on right ventricular (RV) remodeling, particularly in female athletes and across different types of exercise training. Methods: Our study evaluated 370 athletes (61% males) participated at 2020 Tokyo and 2022 Beijing Olympic Games. Athletes were categorized according to main type of exercise into isometric and isotonic. Comprehensive echocardiographic assessments were conducted to analyze RV morpho-functional parameters, comparing genders and different sporting exercise. Results: Significant differences in RV parameters were observed based on exercise type and gender. Isotonic athletes showed greater RV remodeling with larger RV outflow tract (15.1 ± 2.1 vs. 14.5 ± 1.7 mm, p <.0001) end-diastolic and end-systolic area (respectively, 24.6 ± 5.5 vs. 21.7 ± 5 mm, p <.000 and 11.7 ± 3.2 vs. 10.1 ± 2.8 mm, p <.0001) and right atrium size (11.7 ± 3.2 vs. 10.2 ± 2.3 mm2, p =.0001). Functional parameters, such as TDI velocities, were similar between groups. Males showed larger RV area and right atrium size (p <.0001) and lower RV TDI velocities with reduced E′ (15.4 ± 2.9 vs. 16.1 ± 3.2 m/s in females, p =.031), resulting in lower E′/A′ ratio (1.69 ±.6 vs. 1.84 ±.6 m/s, p =.021), while S′ was lower females (14.6 ± 2.3 vs. 14.1 ± 2.4 m/s, p =.041). RV TDI velocities were similar in isotonic and isometric both in male and females. Conclusions: In elite athletes, RV morphological changes are influenced by exercise modality but do not translate into functional differences. Female athletes present distinct RV functional profiles, with lower S′ velocities and a higher E′/A′ ratio. Functional RV TDI parameters are not affected by the typology of exercise practiced.