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Title: Right ventricular structure and function in elite athletes in relation to pre-participation screening
Author: Qasem, M.
ISNI:       0000 0004 7659 2145
Awarding Body: Liverpool John Moores University
Current Institution: Liverpool John Moores University
Date of Award: 2018
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Cardiovascular adaptations to long-term high intensity causes physiological remodelling of the Right ventricle (RV) due to frequent exposure to elevated exercise intensity. Evidence suggests dynamic exercise training serves as the primarily stimulator for the RV adaptation. This cardiac adaption might exceed the cut off limit meeting structural criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) disease. Athlete pre-participation screening is focused on detecting pathological conditions like ARVC. Current issues include: indices that differentiated ARVC patients and healthy people; the impact of different levels of dynamic training exposure on the RV structure, function in elite male athletes; insight into the RV structural and functional in those athletes meet the structural TFC (MTFC) for ARVC and those that do not (NMTFC) via utilising 12-leads Electrocardiography (ECG) and echocardiography. Study one is a systematic review and meta-analysis technique that employed a case-control design sought to determine the extent of the RV structural and functional ranges in ARVC. In second study, athletes were grouped according to their sporting discipline using the Mitchell Classification as Low Dynamic (LD), Moderate Dynamic (MD) or High Dynamic (HD) and underwent through traditional and novel echocardiography techniques with a focused and comprehensive assessment of the RV. In study 3, athletes were grouped to MTFC for ARVC and those NMTFC. Study four, retrospective study looking at the 12-lead ECG for athletes in study MTFC compared to NMTFC. The key finding form the first study was a significant differences in a range of structural and functional echocardiographic parameters between ARVC patients and healthy control participants. Patients with ARVC had larger RV outflow tract (RVOT) diameter at short-axis view (mean ± SD; 34 vs. 28 mm P < 0.001) and RV end-diastolic area (23 vs. 18 cm2 P<0.001) compared to healthy controls. ARVC patients also had lower value on conventional and global RV strain (ε) parameters. HD and MD sport disciplines in second study had generally larger absolute and scaled RV structural indices than LD group. There were no between group differences in conventional RV functional indices as well as global RV ε (LD: -23.4 ± 3.1 vs MD: -22.7 ± 2.7 vs HD: -23.5 ± 2.6, %) and strain rate (P > 0.01). The base to apex ε gradient in the RV septum was lower in the MD athletes compared to HD and LD due to a lower apical septal ε which significantly correlated with absolute RV chamber size. In third study, MTFC had larger absolute and scaled RVOT diameter compared to NMTFC (P ˂0.05) but these athletes did not develop a proportional increase in the RV inflow dimensions. MTFC also had lower global RV ε, peak systolic and late diastolic tissue velocity compared to NMTFC. Study four, MTFC had generally normal ECG finding compared to NMTFC. The finding have important implication for cardiovascular screening of athletes.
Supervisor: Oxborough, D. ; George, K. ; Somauroo, J. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
Keywords: RC1200 Sports Medicine