The right ventricle following prolonged endurance exercise: are we overlooking the more important side of the heart? A meta-analysis

Aims: Prolonged endurance exercise is associated with elevated biomarkers associated with myocardial damage and modest evidence of left ventricular (LV) dysfunction. Recent studies have reported more profound effects on right ventricular (RV) function following endurance exercise. We performed a meta-analysis of studies reporting RV function pre-endurance and postendurance exercise.

Methods: We performed a search of peer-reviewed studies with the criteria for inclusion in the analysis being (1) healthy adult participants; (2) studies examining RV function following an event of at least 90 min duration; (3) studies reporting RV fractional area change (RVFAC), RV strain (S), RV ejection fraction (RVEF) or tricuspid annular plane systolic excursion (TAPSE) and (4) studies evaluating RV function immediately (<1 h) following exercise.

Results: Fourteen studies were included with 329 participants. A random-effects meta-analysis revealed significant impairments of RV function when assessed by RVFAC (weighted mean difference (WMD) -5.78%, 95% CI -7.09% to -4.46%), S (WMD 3.71%, 95% CI 2.79% to 4.63%), RVEF (WMD -7.05%, 95% CI -12.3% to -1.8%) and TAPSE (WMD -4.77 mm, 95% CI -8.3 to -1.24 mm). Modest RV dilation was evident in studies reporting RV systolic area postexercise (WMD 1.79 cm(2), 95% CI 0.5 to 3.08 cm(2)). In contrast, no postexercise changes in LV systolic function (expressed as LVFAC or LVEF) were observed in the included studies (standardised mean difference 0.03%, 95% CI -0.13% to 0.18%).

Conclusions: Intense prolonged exercise is associated with a measurable reduction in RV function while LV function is relatively unaffected. Future studies should examine the potential clinical consequences of repeated prolonged endurance exercise on the right ventricle.