Geert Kleinnibbelink

Chapter 1 20 in this thesis is that the RV remodels differently compared to the LV to physiological stimuli, including regular exercise. However, prospective longitudinal evaluation of this hypothesis is lacking. Also, the RV has been under increasing attention as previous studies have linked exercise-induced RV cardiomyopathy to high volumes of exercise training in elite athletes. 18, 31 Insight into the physiological remodelling of the RV might therefore be helpful to contribute in the challenging preparticipation screening for the detection of heart diseases associated with risk for sudden cardiac death. 32 Figure 4 . End-systolic wall stress during rest is lower in the RV compared to the LV but the relative increase is higher during exercise (source: La Gerche et al. 24 ). Pathophysiological remodelling Hypertension in the systemic circulation could lead to a continuous pressure overload of the LV resulting in hypertrophic remodelling. 33 Hypertension can also occur in the pulmonary circulationwhich is referred to as pulmonary hypertension (PH). 34 PH is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg at rest assessed by right heart catheterization (RHC). 34 PH can be classified into five groups according to their similar clinical presentation, pathological findings, haemodynamic characteristics and treatment strategy 35 :