Right ventricular function in athletes engaged in endurance exercise using speckle tracking echocardiography: a meta-analysis

Background: Long-term endurance training is associated with structural, functional, and biochemical markers of cardiac dysfunction in highly trained athletes. Many studies have focused on structural changes in the right ventricle (RV) and few have examined functional adaptation of the right ventricle. This meta-analysis aims to compare the changes in right ventricular systolic function between endurance athletes and controls before and after exercise using speckle tracking echocardiography (STE).

Methods: A comprehensive search of relevant studies published before March 19, 2024 that examined RV systolic function using speckle tracking technology was conducted. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used as pooled statistics. Meta regression was employed to identify sources of heterogeneity and publication bias was evaluated by Egger's test and funnel plots. Sensitivity analysis was performed by removing sources of significant change from the results of a single publication to evaluate the stability of the results.

Results: Twenty studies were included with 1186 participants. A fixed effect meta-analysis revealed RV global longitudinal strain (GLS) WMD = 0.40, 95% CI (-0.08 ~ 0.89), p = 0.102 and free wall longitudinal strain (FWLS) WMD = 0.62, 95% CI (0.28 ~ 0.96), p < 0.001, random effect models of RV basal strain WMD = 2.94, 95% CI (2.00 ~ 3.88), p < 0.001 and RV apical strain WMD = -0.79, 95% CI (-1.95, 0.37), p = 0.245 between endurance athletes and controls. In addition, a random-effects meta-analysis revealed significant impairments in RV function when assessed by comparing RV GLS pre-endurance versus post endurance exercise WMD = 2.51, 95% CI (1.634 ~ 3.40), p < 0. 001.

Conclusion: The evidence obtained thus far suggests that reporting only global right ventricular strain data may obscure segment-specific adaptation changes, and the use of global and segmental strain analysis may help to identify potential functional changes in the right ventricle while differentiating between normal endurance athletes and non-active controls.