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Original Research: PULMONARY VASCULAR DISEASE |

Range in Pulmonary Artery Systolic Pressure Among Highly Trained Athletes

Antonello D’Andrea, MD, PhD; Robert Naeije, MD; Michele D’Alto, MD,; Paola Argiento, MD; Enrica Golia, MD; Rosangela Cocchia, MD; Lucia Riegler, MD; Raffaella Scarafile, MD; Giuseppe Limongelli, MD; Giovanni Di Salvo, MD; Rodolfo Citro, MD; Pio Caso, MD; Maria Giovanna Russo, MD; Raffaele Calabrò, MD; Eduardo Bossone, MD, PhD, FCCP
Author and Funding Information

From the Department of Pathophysiology (Dr Naeije), Erasme University Hospital, Erasme Campus, Brussels, Belgium; the Department of Cardiology (Dr Citro) University of Salerno, Salerno, Italy; the Department of Cardiac Surgery (Dr Bossone), Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy; and the Department of Cardiology (Drs D’Andrea, D’Alto, Argiento, Golia, Cocchia, Riegler, Scarafile, Limongelli, Di Salvo, Caso, Russo, and Calabrò), Second University Naples, Naples, Italy.

Correspondence to: Eduardo Bossone, MD, PhD, FCCP, Via Principe Amedeo, 36, 83023 Lauro (AV), Italy; e-mail: ebossone@hotmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):788-794. doi:10.1378/chest.10-1260
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Background:  Although the physiologic range of pulmonary artery systolic pressure (PASP) has been reported, data on how it is manifested in athletes are limited. The aim of the present study was to explore the full spectrum of PASP and the long-term training impact in a large population of highly trained athletes.

Methods:  Six hundred fifteen consecutive athletes (370 endurance-trained athletes [ATEs] vs 245 strength-trained athletes [ATSs]; 28.4 ± 10.1 years old) and 230 healthy control subjects (27.5 ± 11.3 years old) underwent transthoracic echocardiography. PASP was estimated by measuring maximal tricuspid regurgitant jet velocity (TRV) with the modified Bernoulli equation. The ratio of TRV to right ventricular outflow tract time-velocity integral (TRV/RVOTTVI) was obtained as a correlate of pulmonary vascular resistance (PVR).

Results:  Left ventricular (LV) mass index and ejection fraction did not differ significantly between the two groups of athletes. Conversely, ATSs showed an increased sum of wall thickness and relative wall thickness, whereas LV end-diastolic diameter, LV stroke volume, peak TRV, and PASP were significantly higher in ATEs. The ratio between transmitral E wave and tissue Doppler e′ wave was not different among the three groups. The ratio TRV/RVOTTVI was ≤ 0.2 (ie, normal PVR) in all subjects. A TRV value > 2.5 m/s was observed in 76 athletes (12.3%). By multivariable analysis, age (P < .01), type and duration of training (P < .01), and LV stroke volume (P < .001) were the only independent predictors of PASP in athletes.

Conclusions:  This study delineates the full range of resting TRV and derived PASP in highly trained athletes. The upper physiologic limit of PASP in endurance athletes may reach 40 mm Hg, in line with the greater increase in stroke volume. This should be considered a “physiologic phenomenon” when evaluating athletes for sports eligibility.

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