Clinical Investigation
Left Ventricular Mechanics
Left Ventricular Myocardial Velocities and Deformation Indexes in Top-Level Athletes

https://doi.org/10.1016/j.echo.2010.09.020Get rights and content

Background

The aim of this study was to define the range of left ventricular (LV) velocities and deformation indexes in highly trained athletes, analyzing potential differences induced by different long-term training protocols.

Methods

Standard echocardiography, pulsed-wave tissue Doppler echocardiography, and two-dimensional strain echocardiography of the interventricular septum and lateral wall were performed in 370 endurance athletes and 280 power athletes. Using pulsed-wave tissue Doppler, the following parameters of myocardial function were assessed: systolic peak velocities (Sm), early (Em) and late (Am) diastolic velocities, and the Em/Am ratio. By two-dimensional strain echocardiography, peaks of regional systolic strain and LV global longitudinal strain were calculated.

Results

LV mass index and ejection fraction did not significantly differ between the two groups. However, power athletes showed an increased sum of wall thicknesses (P < .01) and relative wall thickness, while LV stroke volume and LV end-diastolic diameter (P < .001) were greater in endurance athletes. By pulsed-wave tissue Doppler analysis, Em and Em/Am at both the septal and lateral wall levels were higher in endurance athletes. By two-dimensional strain echocardiography, myocardial deformation indexes were comparable between the two groups. Em/Am ratios ≥ 1 were found in the overall population, while 90 % of athletes had an Em ≥ 16 cm/sec, Sm ≥ 10 cm/sec, and global longitudinal strain ≤ −16%. Multivariate analyses evidenced independent positive association between Em peak velocity and LV end-diastolic volume (P < .001) and an independent correlation of global longitudinal strain with the sum of LV wall thicknesses (P < .005).

Conclusions

This study describes the full spectrum of systolic and diastolic myocardial velocities and deformation indexes in a large population of competitive athletes.

Section snippets

Study Population

From June 2007 to April 2009, 650 consecutive highly trained athletes were referred to the Sports Medicine Ambulatory Service of Monaldi Hospital (Naples, Italy) for cardiovascular preparticipation screening18 and afterward to our echocardiographic laboratory for the purpose of the present study. All subjects underwent detailed histories, physical examinations, electrocardiography, chest radiography, and comprehensive transthoracic echocardiography, including standard Doppler, pulsed-wave

Clinical Characteristics of the Study Population

Mean age was comparable between the two groups. In accordance with the effects of different training protocols, ATP at rest showed higher heart rates, body surface areas, and systolic blood pressures than ATE (Table 1).

M-Mode and B-Mode Measurements

ATP showed increased sum of wall thicknesses (septum + LV posterior wall), LV relative wall thickness, and ESSc, while LV end-diastolic volume was greater in ATE. LV mass index and LV ejection fraction did not significantly differ between the two groups, while left atrial volume

Discussion

Cardiac adaptations due to high-level training can vary in accordance with the type of sport. In particular, isotonic exercise associated with endurance sports is responsible for a chronic volume overload, with a predominant increase in LV mass and end-diastolic diameters (eccentric hypertrophy). On the other hand, isometric exercise, typical of strength disciplines, induces a prevalent increase in LV mass and wall thickness (concentric hypertrophy). However, athletes involved in high-level

Conclusions

This study provides the full spectrum of systolic and diastolic myocardial velocities and deformation indexes obtained by pulsed-wave tissue Doppler and 2DSE analyses in a large population of competitive athletes practicing different sports. The majority of athletes had Em ≥ 16 cm/s, Sm ≥ 10 cm/s, and GLS < −16%. In particular, LV early diastolic myocardial function appears to be positively influenced by preload increase, while increased LV wall thickness seems to induce an enhancement of

References (30)

Cited by (81)

  • Echocardiogram in athlete’s heart

    2023, Athlete's Heart: A Multimodal Approach - From Physiological to Pathological Cardiac Adaptations
  • Gray zones in athlete’s heart

    2023, Athlete's Heart: A Multimodal Approach - From Physiological to Pathological Cardiac Adaptations
  • Recommendations on the Use of Multimodality Cardiovascular Imaging in Young Adult Competitive Athletes: A Report from the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Computed Tomography and the Society for Cardiovascular Magnetic Resonance

    2020, Journal of the American Society of Echocardiography
    Citation Excerpt :

    This reflects the fact that stroke volume, not ejection fraction, is physiologically regulated with large ventricles ejecting a lower fraction of end-diastolic volume than smaller ventricles under resting conditions. However, studies using pulsed-wave Doppler, tissue Doppler, and speckle-tracking echocardiography have shown that endurance CA typically demonstrate preserved or enhanced systolic function.64,72,79-81 EICR is not confined to the LV.

View all citing articles on Scopus
View full text