Publication: Valoración ecocardiográfica del ventrículo derecho en deportistas de élite: estudio comparado sobre el ventrículo derecho en deportistas con diferente componente dinámico y estático
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2017-08-31
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Universidad Complutense de Madrid
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Abstract
Durante la práctica del ejercicio físico el organismo experimenta diversos cambios en su funcionamiento con el fin de atender a la mayor demanda de oxígeno y nutrientes del músculo activo. La práctica de ejercicio físico se asocia a cambios hemodinámicos que alteran las condiciones de carga del corazón; el ejercicio dinámico se asocia con un incremento de los volúmenes cardiacos, mientras que el ejercicio estático se caracteriza por el gran aumento de las resistencias vasculares periféricas, produciendo una sobrecarga de presión sobre el corazón. Con la práctica de un entrenamiento regular y mantenido en el tiempo, estos cambios dan lugar a una serie de adaptaciones a nivel del sistema cardiovascular que se han agrupado bajo la denominación de “corazón del deportista”, caracterizado por un aumento de las dimensiones de todas las cavidades cardiacas y de los grosores de las paredes. Se ha descrito una adaptación diferente en función del deporte practicado, tipo dinámico o estático, sin embargo, la mayoría de los deportes presentan un grado variable de ambos componentes. El remodelado cardiaco también vendrá determinado por factores como la intensidad y la duración del entrenamiento, el sexo, la raza y el tamaño corporal. Tradicionalmente los estudios del corazón del deportista se han centrado en las adaptaciones del VI y en su diagnóstico diferencial con la miocardiopatía hipertrófica, una de las principales causas de muerte súbita del deportista. Hasta hace poco tiempo eran escasos los estudios en los que se hacía referencia a los rangos de normalidad de los parámetros ecocardiográficos del VD, tanto en la población general como en los deportistas. Sin embargo el estudio ecocardiográfico del VD sigue estando dificultado por factores como la compleja geometría de esta cavidad cardiaca, la limitada definición de la superficie endocárdica a consecuencia de la mayor trabeculación, su situación retroesternal que dificulta el paso de los ultrasonidos y la marcada dependencia de la carga en los índices de función del VD. Anatómicamente al VD se le divide en tres partes: tracto de entrada (válvula tricúspide, sus cuerdas tendinosas y los músculos papilares), extremo apical (muy trabeculado) y tracto de salida (con un miocardio liso que desemboca en la arteria pulmonar). En el niño maduro y en el adulto sanos, la pared del VD es mucho más delgada que la del VI, ya que bombea la sangre contra un circuito de menor presión. Una particularidad del VD es que se pueden producir grandes cambios en el tamaño y la forma del VD en función de las condiciones de carga, ya que se trata de una cámara diseñada para acomodar el retorno venoso sistémico y enviarlo hacia un sistema de alto flujo y baja presión. Se trata por tanto de una cámara cardiaca muy sensible a los incrementos agudos de la presión arterial pulmonar (postcarga), que sin embargo tolera relativamente bien la sobrecarga de volumen (precarga)...
During physical activity the body undergoes a number of physiological changes in order to meet the increased demand for oxygen and nutrients from the active muscles. It`s associated with hemodynamic changes that alter the loading conditions of the heart. For example, dynamic exercise is associated with increased cardiac volumes; meanwhile static exercise is characterized by a large increase in peripheral vascular resistance, producing a pressure overload on the heart. Regular training during prolonged time lead to a number of changes to the cardiovascular system that have been grouped under the name "athlete's heart"; characterized by an increase in heart’s dimensions and wall thicknesses. It had been described different types of adaptations according to the sport discipline, in terms of dynamic or static component; however, most sports show a variable degree of both. Thus cardiac remodeling is also determined by factors such intensity and duration of training, sex, race and body size. Traditionally athlete’s heart studies have focused the attention on left ventricle (LV) adaptation and its differential diagnosis with hypertrophic cardiomyopathy, one of the leading causes of sudden death in athletes. Until recently, only few studies were referred to the normal range of echocardiographic parameters of the right ventricle (RV) in the general population and also in athletes. However echocardiography of the RV remains hampered by factors such as: the complex geometry of the heart chamber, the narrow definition of the endocardial surface as a result of greater trabeculation, retrosternal situation hinders the passage of ultrasound and the dependence of the RV function according to the load. Anatomically the RV is divided into three parts: the inflow tract (tricuspid valve chordae and its papillary muscles), the apex (very trabecular) and the outflow tract (with smooth endocardium muscle attack that ends at the pulmonary artery). RV wall is much thinner than LV, as it pumps blood against a lower pressure circuit. A peculiarity of the RV is that large changes in the size and shape are seen according to load conditions, because it is a chamber designed to accommodate the systemic venous return and send it to a system of high flow and low pressure. Therefore is a cardiac chamber very sensitive to acute increases in pulmonary arterial pressure (afterload), while the volume overload it’s well tolerated (preload)...
During physical activity the body undergoes a number of physiological changes in order to meet the increased demand for oxygen and nutrients from the active muscles. It`s associated with hemodynamic changes that alter the loading conditions of the heart. For example, dynamic exercise is associated with increased cardiac volumes; meanwhile static exercise is characterized by a large increase in peripheral vascular resistance, producing a pressure overload on the heart. Regular training during prolonged time lead to a number of changes to the cardiovascular system that have been grouped under the name "athlete's heart"; characterized by an increase in heart’s dimensions and wall thicknesses. It had been described different types of adaptations according to the sport discipline, in terms of dynamic or static component; however, most sports show a variable degree of both. Thus cardiac remodeling is also determined by factors such intensity and duration of training, sex, race and body size. Traditionally athlete’s heart studies have focused the attention on left ventricle (LV) adaptation and its differential diagnosis with hypertrophic cardiomyopathy, one of the leading causes of sudden death in athletes. Until recently, only few studies were referred to the normal range of echocardiographic parameters of the right ventricle (RV) in the general population and also in athletes. However echocardiography of the RV remains hampered by factors such as: the complex geometry of the heart chamber, the narrow definition of the endocardial surface as a result of greater trabeculation, retrosternal situation hinders the passage of ultrasound and the dependence of the RV function according to the load. Anatomically the RV is divided into three parts: the inflow tract (tricuspid valve chordae and its papillary muscles), the apex (very trabecular) and the outflow tract (with smooth endocardium muscle attack that ends at the pulmonary artery). RV wall is much thinner than LV, as it pumps blood against a lower pressure circuit. A peculiarity of the RV is that large changes in the size and shape are seen according to load conditions, because it is a chamber designed to accommodate the systemic venous return and send it to a system of high flow and low pressure. Therefore is a cardiac chamber very sensitive to acute increases in pulmonary arterial pressure (afterload), while the volume overload it’s well tolerated (preload)...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 26-01-2016