Analysis of athletes’ heart by tissue Doppler and strain/strain rate imaging

Abstract

After regular and prolonged training, some physical and structural changes occur in the heart. Strain (S) imaging and Strain Rate (SR) imaging are new and effective techniques derived from tissue Doppler imaging (TDI) which examine systolic and diastolic functions. The aim of the present study was to evaluate left ventricular TDI and S/SR imaging properties in athletes and sedentary controls. The study population consisted of 26 highly trained athletes (group I) and age, sex and body mass index (BMI) adjusted 23 control subjects (group II) who had no pathological conditions. Using standard transthoracic and Doppler echocardiographical measurements and reconstructed spectral pulsed wave tissue Doppler velocities, the S/SR imaging of six different myocardial regions were evaluated. There was a significant increase in left ventricular systolic (LVSD) and diastolic (LVDD) diameter, inter-ventricular septum (IVS), left ventricular mass (LVm), left atrial diameter (LA), and transmitral Doppler peak E velocity (flow velocity in early diastole) between group I and group II in the case of echocardiographic findings. In athletes, TDI analysis showed a significantly increased mitral annulus lateral TDI peak early diastolic (E) velocity (18.8 ± 4.1 cm/s vs. 15 ± 3.5 cm/s, P < 0.01), septal TDI peak E velocity (15.8 ± 2.8 cm/s vs. 12.8 ± 2.4 P < 0.001). There were no significant differences in myocardial velocity imaging parameters between group I and group II. Peak systolic strain/strain rates of septal and lateral walls in group I were significantly higher than group II. This study demonstrates that left ventricular S/SR imaging was higher in athletes than in healthy subjects. In addition to traditional echocardiographic parameters, SI/SRI could be utilised as a useful echocardiographic method for cardiac functions of athletes.

Patterns of Left Ventricular Diastolic Function in Olympic Athletes

“…28 Another possible explanation for this phenomenon is the hypothesis that under resting condition, the untwisting of the left ventricle occurs at a lower velocity (as also demonstrated by an increased IVRT), with a consequently slower decay in LV pressure needed to generate the suction forces 40 ; however, the untwisting forces may become more relevant during exercise and at higher heart rates to generate more efficient filling of the left ventricle. 41 Our results are partially different from those of previous studies, which are largely heterogeneous: the E/A ratio was reported to be unchanged by some authors 42,43 but increased by others 16,37 ; certain studies reported increased E-wave velocity, 20,37 whereas most the others showed that it was unchanged 14,36,37 ; and e 0 velocity was increased in some studies 18,37,43 and unchanged in others. 14,16,36 These marked differences are likely due to the restricted and selected athlete populations included in previous studies, which do not allow a complete picture of diastolic function in athletes.…”

“…[14][15][16][17][18]36,37 However, within the broad spectrum of sport disciplines included in the present study, we observed a small but nonnegligible subset of athletes (3%) with E/A ratios > 3.0, sometimes up to 4.8. Therefore, a practical clinical consequence of this observation is that in elite athletes, LV filling should not raise suspicion of a restrictive filling pattern, despite the marked increase of E/A ratio (>3) and the presence of LA enlargement, 38,39 In this context, the normal DTI e 0 velocity and E/e 0 ratio, the normal PASP, and the overall clinical picture may help avoid the misdiagnosis of a pathologic cardiac condition.…”

“…The clinical significance of this observation is that in elite athletes, regardless the extent of LV remodeling, the absolute e 0 value is consistently >8.0 cm/sec, 14,[16][17][18]37 and values below this cutoff should be interpreted with some clinical caution. [23][24][25]35 In fact, individuals with positive genotype and negative phenotype for hypertrophic cardiomyopathy may already have abnormal e 0 velocities, underscoring the principle that abnormal diastolic function may precede the development of patent LV hypertrophy.…”

“…So far, several studies have explored LV diastolic function in a variety of athletes, with, however, substantial limitations regarding the small number of subjects examined and/or the restricted representation of the sport disciplines. [12][13][14][15][16][17][18][19][20][35][36][37] Accurate understanding of the diastolic properties may help define the physiologic nature of LV remodeling in athletes and help distinguish it from pathologic cardiac conditions, such as hypertrophic cardiomyopathy, which may mimic the morphologic characteristics of the athlete's heart, but is usually associated with early impairment of diastolic performance. 11,[21][22][23][24][25]35 In the present study, we planned a comprehensive assessment of LV diastolic function, derived from a large cohort of elite athletes, of both genders and encompassing a broad variety of sport disciplines.…”

Cardiac function and long-term volume load : Physiological investigations in endurance athletes and in patients operated on for aortic regurgitation

“…A few studies reporting segmental strain in the basal LV septal and lateral wall segment found deformation to be either concomitantly similar, 145 concomitantly higher in ATH than in CON, 134 or higher in CON in the basal septum but not in the basal lateral LV wall.…”