In total, 6,806 and 740 competitive athletes were included for the echocardiographic and CMR quantification of the RV, respectively. In this review, we present normal reference values for RV size and function to be applied in competitive athletes according to the disciplines practiced. The reference ranges reported in this review suggest that physicians should be aware that application of the current recommendations for normal population could be misleading when evaluating athletes. We suggest using these normative reference values, obtained in competitive athletes, to avoid the potential for mistakenly concluding, in this specific population, that RV size or function are abnormal.
Physicians should be aware that the application of the current recommendations for the normal population could be misleading when evaluating athletes. In the present systematic review and meta-analysis, we derived normative values for RV echocardiographic and CMR dimensions to be applied in competitive athletes to properly assess the presence and extent of RV dilatation. The extent of RV remodeling is particularly evident in athletes practicing combined disciplines. The application of the proposed cut-offs would prevent misleading interpretation of echocardiographic RV assessment and unwarranted exclusion from sports participation in athletes exhibiting physiologic RV enlargement. Conversely, measurements greatly exceeding the athlete-derived limits here reported are unlikely to represent a uniquely physiologic adaptation to training and should raise suspicion of a pathological cardiac condition.
