In April, CRY’s Research Fellows attended EuroPRevent 2011. Organised by the European Society of Cardiology (ESC), it is the biggest meeting in Europe on Cardiovascular prevention and rehabilitation. Held over 3 days, it includes meetings, presentations and courses with the aim of advancing knowledge. Both existing and previous CRY Research Fellows presented their research to attendees from all over the world.
CRY Research Fellow Dr Abbas Zaidi was nominated for the Young Investigator of the Year Award and also presented some of his other work during a symposium ‘Beyond the left ventricle’.
- What was the symposium Beyond the Left Ventricle about?
Most of the work that’s been done in sports cardiology has focussed on the left ventricle. Most of Professor Sanjay Sharma’s work to date has been about the left ventricle; thickening of the left ventricular wall, dilation of the left ventricular cavity and distinguishing remodeling of the left ventricle that athletes get from hypertrophic cardiomyopathy (HCM). HCM is a condition that can cause sudden death in young people, particularly athletes, and in athletes the left ventricle thickens up and enlarges so you can get this difficulty in distinguishing the normal athlete’s left ventricle from HCM, but there’s not been much work done on what happens to the right side of the heart in athletes. So basically the symposium was predominantly about what happens to the right side of the heart in athletes.
- Why has the focus been on the left ventricle?
Firstly, the left ventricle is easier to study. It’s a symmetrical structure which can be studied quite easily with echocardiography whilst the right ventricle is an asymmetrical structure and is much more difficult to see and to study with echocardiography. Secondly, HCM is more common and is more recognised whilst arrhythmogenic right ventricular cardiomyopathy (ARVC) has only recently been recognised as a condition that can cause sudden death in athletes so the focus has always been on trying to pick up HCM. It’s only really recently that we’ve started looking for ARVC.
- You say that most previous research has focussed on HCM and that ARVC is more recent. What do you mean by more recent?
I guess it’s the work of the Italians. The Italians were the ones who really sort of started to pick up quite a lot of cases of ARVC. So it’s only really become prominent within the last 10 years really.
People haven’t really been looking for it (in athletes) until the last 10 years.
- What was your talk about?
My talk was about the structural adaptations of the right ventricle in athletes so I talked about the fact that sudden deaths occur in young people in sport, then I talked about the fact that a lot of work has been done on the left ventricle then I talked about the why the right ventricle hasn’t been studied as much and then I reviewed the literature about what happens to the right ventricle in athletes. Most of the literature suggests that there are changes in the right ventricle in athletes and that the right ventricle enlarges. However, there is conflicting evidence about what happens to the function of the right ventricle. Some evidence suggests that, although the right heart gets bigger, the function stays the same but there is also some evidence that suggests that intense prolonged exercise over many years can actually cause some damage to the right ventricle. Then I also presented our own data from my work with Professor Sharma which is funded by CRY. We are studying a large cohort of athletes that we’ve screened from CRY screenings and we’re making measurements on their right hearts, so I presented some of the data that we’ve got so far.
- What are your preliminary findings?
Our preliminary findings confirmed earlier work that the right ventricle does enlarge quite a lot in competitive athletes. Also the right heart gets so big in some athletes that they start to fulfil diagnostic criteria for ARVC although they don’t actually have it.
Is that because the exercise works the heart muscle and so it enlarges?
It’s basically because more blood is flowing through the right ventricle because it’s got a higher throughput of blood so it has to enlarge to accommodate the greater throughput of blood. Also the pulmonary artery pressure rises in athletes so the pressure in the right side of the heart increases so there’s greater flow and greater pressure. As they are pushing their body with intense exercise, they need their heart to work more efficiently which affects the left and right side of their heart.
- How is this relevant in day-to-day practice?
We see a lot of athletes, especially in Professor Sharma’s clinic because he’s the head of the CRY Sports Cardiology Centre, with large right ventricles and if they have ARVC then they should be excluded from sport because they are at risk of sudden death. They increase their risk of death by exercising so if they have a large ventricle we need to know what normal is for an athlete, because normal for an athlete is bigger than it is for a non-athlete. Once we’ve established what normal is for athletes then we won’t need to put them all through the tests because we’d be able to say this is normal for you because you do a lot of exercise.
- How would this relate to the work that CRY does and the CRY screening programme?
All of the data has come from CRY screenings and ARVC is an inherited cardiac condition that kills a significant proportion of young athletes and young people in general. If it helps with the identification of people with this condition then it will reduce sudden deaths in young people.
- Would these changes in the right ventricle also show up on the ECG or is it just on the ECHO?
That’s another thing we’re looking at actually: whether we can predict these changes on the ECG and whether or how we can use the ECG as another tool to differentiate healthy right ventricle enlargement from ARVC.
