Journal
EUROPEAN JOURNAL OF HEART FAILURE
Volume 16, Issue 12, Pages 1337-1344Publisher
WILEY
DOI: 10.1002/ejhf.181
Keywords
Arrhythmogenic cardiomyopathy; Heart failure; Exercise; Myocardial function; Ventricular arrhythmia
Categories
Funding
- South-Eastern Norway Regional Health Authority
- Centre for Cardiological Innovation - Research Council of Norway
- Swedish National Health Service
- Swedish Heart-Lung Foundation
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AimsExercise increases risk of ventricular arrhythmia in subjects with arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed to investigate the impact of exercise on myocardial function in ARVC subjects. Methods and ResultsWe included 110 subjects (age 4217years), 65 ARVC patients and 45 mutation-positive family members. Athletes were defined as subjects with 4h vigorous exercise/week [1440 metabolic equivalents (METsxminutes/week)] during a minimum of 6 years. Athlete definition was fulfilled in 37/110 (34%) subjects. We assessed right ventricular (RV) and left ventricular (LV) myocardial function by echocardiography, and by magnetic resonance imaging (MRI). The RV function by RV fractional area change (FAC), RV global longitudinal strain (GLS) by echocardiography, and RV ejection fraction (EF) by MRI was reduced in athletes compared with non-athletes (FAC 34 +/- 9% vs. 40 +/- 11%, RVGLS -18.3 +/- 6.1% vs. -22.0 +/- 4.8%, RVEF 32 +/- 8% vs. 43 +/- 10%, all P<0.01). LV function by LVEF and LVGLS was reduced in athletes compared with non-athletes (LVEF by echocardiography 50 +/- 10% vs. 57 +/- 5%, LVEF by MRI 46 +/- 6% vs. 53 +/- 8%, and LVGLS -16.7 +/- 4.2% vs. -19.4 +/- 2.9%, all P<0.01). The METsxminutes/week correlated with reduced RV and LV function by echocardiography and MRI (all P<0.01). The LVEF by MRI was also reduced in subgroups of athlete index patients (46 +/- 7% vs. 54 +/- 10%, P=0.02) and in athlete family members (47 +/- 3% vs. 52 +/- 6%, P<0.05). Conclusion Athletes showed reduced biventricular function compared with non-athletes in ARVC patients and in mutation-positive family members. The amount and intensity of exercise activity was associated with impaired LV and RV function. Exercise may aggravate and accelerate myocardial dysfunction in ARVC.
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