Assessment Of Training Intensity On Right Ventricular Function In Amateur Marathoners By Three-dimensional Speckle Tracking Echocardiography

Objective:Three-dimensional speckle tracking echocardiography（3D-STE）was used to quantitatively assess right ventricular（RV）function in amateur marathon runners,to investigated the effects of training intensity on RV structure and function,and to provide reliable information for clinical training guidance.Methods:A total of 53 amateur marathon runners with 3 years of running experience in Hangzhou from November 2020 to December 2022 were selected as the athlete group.According to the training intensity,they were divided into two groups:group A（average training intensity<45.0 km/week）and group B（average training intensity≥45.0 km/week）.At the same time,26 healthy people who underwent physical examination in the Affiliated Hospital of Hangzhou Normal University were enrolled as the control group.Conventional echocardiography combined with 3D-STE were performed on all subjects,and the athlete group were screened using echocardiography a week before marathon,within 1h post marathon,and 4days post marathon.Relevant parameters of conventional echocardiography obtained are as follows:right atrial long diameter（RAD1）,right atrial transverse diameter（RAD2）,RV fraction area change（2D-RVFAC）,tricuspid annular plane systolic excursion（2D-TAPSE）,tricuspid valve velocity peak early diastolic（E）,peak atrial diastolic（A）and E/A ratio,lateral wall of the tricuspid annulus velocity peak systolic（S’）,peak early diastolic（e’）and E/e’ratio,RV myocardial work index（RMPI）and pulmonary arterial systolic pressure（PASP）;3D-STE parameters obtained are as follows:RV end-diastolic volume（RVEDV）,RV end-systolic volume（RVESV）,stroke volume（SV）,RV basal segment diameter（RVD1）,RV middle segment diameter（RVD2）,RV longitudinal diameter（RVLD）,3D-RVFAC,3D-TAPSE,RV ejection fraction（RVEF）,RV global longitudinal strain（RVGLS）,RV free wall longitudinal strain(RVLS _Free)and RV septal wall longitudinal strain(RVLS _Septal).The differences of the above parameters were compared,and the correlation between 3D-STE parameters and RVEF and the correlation between 3D-STE and training intensity were analyzed.Results:1.General information.Compared with the control group,the heart rate of group A was significantly reduced.Compared with the control group and group A,the heart rate of group B was significantly reduced.Compared with group A,the training intensity of group B was significantly increased（all P<0.05）.2.Conventional echocardiographic parameters.Inter-group comparison:compared with the control group,RAD1,RAD2,E/e’in group A were significantly increased.Compared with the control group and group A,RAD1,RAD2,RMPI and PASP in group B were significantly increased（all P<0.05）.Intra-group comparison:E/A was significantly decreased,E/e’,RMPI and PASP were significantly increased in group A and group B 1 hour after the race（all P<0.05）.3.3D-STE parameters.Inter-group comparison:compared with the control group,RVEDV,SV,3D-RVFAC,3D-TAPSE,RVEF,RVGLS and RVLS _Free in group A were significantly increased.Compared with control group and group A,RVEDV and RVESV in group B were significantly increased,3D-RVFAC,3D-TAPSE,RVGLS and RVLS _Free were significantly decreased.Compared with group A,RVEF and RVLS _Septal in group B were significantly decreased,RVLD was significantly increased（all P<0.05）.Intra-group comparison:3D-RVFAC,3D-TAPSE,RVGLS and RVLS _Freewere significantly decreased in group A and group B within 1 hour after the race（all P<0.05）,and the decrease was larger in group A.RVEF had no statistically significant difference within 1 hour after the race（P>0.05）.4.Correlation analysis.3D-RVFAC,3D-TAPSE,RVGLS,RVLS _Free and RVLS _Septal all significantly correlated with RVEF（r=0.473,0.543,-0.592,-0.562,-0.482,respectively,all P<0.001）.The RVEDV of marathon runners was positively correlated with training intensity（r=0.547,P<0.001）,among them,group A（r=0.526,P<0.001）,group B（r=0.532,P<0.001）.Conclusions:1.When training intensity for amateur runner is within normal range,the change in RV is mainly reflected by the increase in RV volume;When the training intensity exceeds a certain intensity,the RV longitudinal systolic function may decline.2.RV systolic and diastolic function of amateur marathon runners can be temporarily decreased after full marathon,and the lower the training intensity,the more significant the decline of RV function.3.Quantitative analysis of 3D-STE can sensitively and accurately evaluate RV systolic function in amateur marathon runners,providing a reliable reference for clinical guidance of training.