Athletes and Right Heart Dysfunction: André La Gerche

About Professor André La Gerche

Professor La Gerche is a cardiologist and researcher based in Melbourne, Australia. He leads the HEART Lab at St Vincent’s Institute, focusing on how exercise affects cardiovascular health. He has pioneered imaging techniques such as exercise cardiac MRI and contrast echocardiography.

Just asked AI and the summary is pretty much what was in the talk!

Imaging the Heart Immediately After Strenuous Exercise

• Intense endurance exercise can cause acute right ventricular (RV) dysfunction.
• RV volumes increase and RV ejection fraction decreases post-exercise.
• Biomarkers like troponin and BNP rise and correlate with reduced RV function.
• Delayed gadolinium enhancement (DGE) on MRI shows myocardial fibrosis in some athletes.
• Changes often resolve within a week, but chronic remodeling may persist.

Exercise-Induced Pulmonary Hypertension and the Right Heart

• Exercise increases pulmonary artery pressure (PAP) linearly with cardiac output.
• RV wall stress rises significantly more than LV wall stress during exercise.
• RV dilation, hypertrophy, and reduced resting RV function can occur in endurance athletes.
• Some remodeling mimics arrhythmogenic right ventricular cardiomyopathy (ARVC).

Clinical Implications

• RV dysfunction post-exercise may increase risk of ventricular arrhythmias.
• Exercise imaging helps identify at-risk athletes who appear normal at rest.
• Exercise-induced RV cardiomyopathy is being explored as a clinical entity.

References

1. La Gerche A et al. Exercise-induced right ventricular dysfunction and structural remodeling in endurance athletes. European Heart Journal, 2012.
2. La Gerche A et al. Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and RV function during exercise. J Appl Physiol, 2010.
3. La Gerche A et al. The response of the pulmonary circulation and right ventricle to exercise. Grover Conference Series, 2013.
4. La Gerche A et al. Exercise-induced RV dysfunction is associated with ventricular arrhythmias in endurance athletes. European Heart Journal, 2015.
5. Elliott AD, La Gerche A. The right ventricle following prolonged endurance exercise: a meta-analysis. Br J Sports Med, 2014.

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