Endurance Training Minimizes Age-Related Changes of Left Ventricular Twist-Untwist Mechanics

Maufrais, Claire; Schuster, Iris; Doucende, Grégory; Vitiello, Damien; Rupp, Thomas; Dauzat, M.; Obert, Philippe; Nottin, Stéphane

doi:10.1016/j.echo.2014.07.007

Cited by 43 publications

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“…Endurance training (eg, marathon runners) increases all resting myocardial mechanics, including apical rotational velocity, LVT, and untwist with reduced age-related effects on twist-untwist mechanics. 20 Strength training (eg, weight lifters), however, is not known to be associated with these differences. Exercise-related twist reserve becomes blunted by age and in the presence of myocardial dysfunction.…”

Section: Effect Of Exercisementioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

105

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A 52-year-old white man visited his physician because he started experiencing shortness of breath on walking short distances at ground level. He had smoked half a packet of cigarettes daily for 40 years. Physical examination revealed a blood pressure of 147/95 mm Hg. Chest examination and chest x-ray were unremarkable, and ECG showed left atrial abnormality. The patient had normal serum electrolytes, blood sugar, and kidney function tests. A stress echocardiogram was ordered to exclude potential coronary artery disease. His resting echocardiography showed an ejection fraction (EF) of 60%, normal septal and posterior wall thickness, and mild diastolic dysfunction (septal early diastolic mitral annular velocity [e′] of 7 cm/s, early diastolic [E wave] to late diastolic [A wave] transmitral Doppler flow velocity ratio [E/A] of 1.4, E-wave deceleration time of 210 ms, E/e′ ratio of 9, and left atrial volume index of 44 mL/m 2 ; Figure 1A). There were no resting segmental wall motion abnormalities suggestive of ischemia. The patient exercised on a treadmill using Bruce protocol for 4 minutes and 43 s, and achieved 6.6 metabolic equivalent of task and maximum heart rate of 148 bpm (88% of his maximum age predicted heart rate). At peak exercise, the patient developed severe dyspnea and his blood pressure was 213/90 mm Hg. Post exercise echocardiography was acquired within 1 minute of exercise termination and showed EF of 69% and no segmental wall motion abnormalities, with Doppler recordings obtained at recovering heart rate of 125 bpm; showing a septal e′ velocity of 7.3 cm/s, E/A of 1.9, E-wave deceleration time of 110 ms, and E/e′ of 13.7, left atrial volume index of 35 mL/m 2 ( Figure 1B). Ten minutes into the recovery period, the blood pressure returned to basal level (145/80 mm Hg). Compared with resting levels, the increased E/A ratio, shortened E-wave deceleration time and relatively increased E/e′ ratio suggested post exercise worsening of diastolic function with elevation of left ventricular (LV) filling pressures. To investigate the mechanistic basis of diastolic dysfunction in this patient, LV deformation was assessed offline using speckletracking echocardiography (STE). Besides characterizing the longitudinal and circumferential shortening, and radial thickening, the LV rotational deformation, that resembles the wringing of a towel, was also measured (Figures 2 and 3). This wringing deformation, also referred to as LV twist (LVT) and the subsequent recoil that occurs in diastole, referred to as untwist, were abnormal in this patient (Figure 4). At rest, the patient had mild diastolic dysfunction, which was associated with a higher than normal LVT and untwist values, compared with the published age-related normal values, 1,2 and low global longitudinal strain. At peak exercise, there was a significant worsening of the patient's diastolic parameters, which was associated with worsening untwist values and further reduction of global longitudinal strain, whereas LVT remained same in magnitude. The following ...

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Section: Effect Of Exercisementioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

105

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“…The full texts of potential articles were examined for eligibility, and 20 investigations were removed because they did not include a control group ( n = 7); group means were outside the age range ( n = 3); athlete and control groups were not aged matched ( n = 2); samples included both sexes ( n = 5), or deformation was not measured with STE ( n = 3). Subsequently, 13 studies including 945 participants (590 athletes and 355 controls) met the inclusion criteria and were used for statistical analyses [10, 23, 28, 30–34, 36–38, 53, 54]. …”

Section: Resultsmentioning

confidence: 99%

“…Data were extracted for twist from studies that reported a single time point at peak or end systole (aortic valve closure). Studies often used untwisting rate (UTR) to refer to peak untwisting velocity (PUV) [32, 34, 47], with peak UTR defined as the PUV occurring during early diastole [30, 48]. UTR has also been used to describe the rate of untwisting occurring during the earliest phases of diastole at timing events prior to mitral valve opening (MVO) [10, 37].…”

Section: Methodsmentioning

confidence: 99%

Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies

et al. 2016

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BackgroundThe athlete’s heart is associated with physiological remodeling as a consequence of repetitive cardiac loading. The effect of exercise training on left ventricular (LV) cardiac strain and twist mechanics are equivocal, and no meta-analysis has been conducted to date.ObjectiveThe objective of this systematic review and meta-analysis was to review the literature pertaining to the effect of different forms of athletic training on cardiac strain and twist mechanics and determine the influence of traditional and contemporary sporting classifications on cardiac strain and twist mechanics.MethodsWe searched PubMed/MEDLINE, Web of Science, and ScienceDirect for controlled studies of aged-matched male participants aged 18–45 years that used two-dimensional (2D) speckle tracking with a defined athlete sporting discipline and a control group not engaged in training programs. Data were extracted independently by two reviewers. Random-effects meta-analyses, subgroup analyses, and meta-regressions were conducted.ResultsOur review included 13 studies with 945 participants (controls n = 355; athletes n = 590). Meta-analyses showed no athlete–control differences in LV strain or twist mechanics. However, moderator analyses showed greater LV twist in high-static low-dynamic athletes (d = –0.76, 95% confidence interval [CI] –1.32 to –0.20; p < 0.01) than in controls. Peak untwisting velocity (PUV) was greater in high-static low-dynamic athletes (d = –0.43, 95% CI –0.84 to –0.03; p < 0.05) but less than controls in high-static high-dynamic athletes (d = 0.79, 95% CI 0.002–1.58; p = 0.05). Elite endurance athletes had significantly less twist and apical rotation than controls (d = 0.68, 95% CI 0.19–1.16, p < 0.01; d = 0.64, 95% CI 0.27–1.00, p = 0.001, respectively) but no differences in basal rotation. Meta-regressions showed LV mass index was positively associated with global longitudinal (b = 0.01, 95% CI 0.002–0.02; p < 0.05), whereas systolic blood pressure was negatively associated with PUV (b = –0.06, 95% CI –0.13 to –0.001; p = 0.05).ConclusionEchocardiographic 2D speckle tracking can identify subtle physiological differences in adaptations to cardiac strain and twist mechanics between athletes and healthy controls. Differences in speckle tracking echocardiography-derived parameters can be identified using suitable sporting categorizations.

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“…RV longitudinal strains were assessed on the free wall (3 segments), from an apical four-chamber view. 2D strain data were processed with a specific toolbox (Scilab 4.1, Consortium Scilab; INRIA-ENPC, Paris, France) (19,25,39). For temporal analysis, this software adjusted all strain variables for intersubject differences in HR and frame rate acquisition.…”

Section: Methodsmentioning

confidence: 99%

Progressive and biphasic cardiac responses during extreme mountain ultramarathon

Maufrais

Millet

Schuster

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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Maufrais C, Millet GP, Schuster I, Rupp T, Nottin S. Progressive and biphasic cardiac responses during extreme mountain ultramarathon. Am J Physiol Heart Circ Physiol 310: H1340 -H1348, 2016. First published February 26, 2016 doi:10.1152/ajpheart.00037.2016.-Investigations on the cardiac function consequences of mountain ultramarathon (MUM) Ͼ100 h are lacking. The present study assessed the progressive cardiac responses during the world's most challenging MUM (Tor des Géants; Italy; 330 km; 24,000 m of cumulative elevation gain). Resting echocardiographic evaluation of morphology, function, and mechanics of left and right ventricle (LV and RV) including speckle tracking echocardiography was conducted in 15 male participants (46 Ϯ 13 yr) before (pre), during (mid; 148 km), and after (post) the race. Runners completed the race in 126 Ϯ 15 h. From pre to post, the increase in stroke volume (SV) (103 Ϯ 19 vs. 110 Ϯ 23 vs. 116 Ϯ 21 ml; P Ͻ 0.001 at pre, mid, and post) was concomitant to the increase in LV early filling (peak E; 72.9 Ϯ 15.7 vs. 74.6 Ϯ 13.1 vs. 82.1 Ϯ 11.5 cm/s; P Ͻ 0.05). Left and right atrial end-diastolic areas, RV end-diastolic area, and LV enddiastolic volume were 12-19% higher at post compared with pre (P Ͻ 0.05). Resting heart rate and LV systolic strain rates demonstrated a biphasic adaptation with an increase from pre to mid (55 Ϯ 8 vs. 72 Ϯ 11 beats/min, P Ͻ 0.001) and a return to baseline values from mid to post (59 Ϯ 8 beats/min). Significant correlations were found between pre-topost percent changes in peak E and LV end-diastolic volume (r ϭ 0.63, P Ͻ 0.05) or RV (r ϭ 0.82, P Ͻ 0.001) or atrial end-diastolic areas (r ϭ 0.83, P Ͻ 0.001). An extreme MUM induced a biphasic pattern of heart rate in parallel with specific cardiac responses characterized by a progressive increase in diastolic filling, biventricular volumes, and SV. IT IS WELL DOCUMENTED THAT prolonged intense exercise, such as a marathon or Ironman triathlon, transitorily alters cardiac function (7,13,20,22,23,28,42). A range of 3-15 h exercising induces transient left ventricular (LV) global systolic (20, 42) and diastolic (7,23,28) dysfunctions. This phenomenon, named exercise-induced cardiac fatigue (EICF), is generally associated with the release of biochemical markers of myocardial damage (13,22).Whereas the impact of races such as marathons or Ironman triathlons has been extensively described, few studies have explored cardiac function after ultraendurance exercise. After 24 -26 h of exercise, previous studies observed a depressed diastolic function (5,24,29,30,35). However, conflicting results were observed on systolic function because ejection fraction (EF) was either decreased (24, 29, 35) or unchanged (5, 30). Recently, we evaluated the cardiac function consequences of a mountain ultramarathon (MUM) (i.e., 38 Ϯ 5 h). It is important to note that an important decrease in velocity (e.g., large deceleration) has been reported in the MUM of the present study (34), caused by the combination of extreme distance and sleep d...

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Endurance Training Minimizes Age-Related Changes of Left Ventricular Twist-Untwist Mechanics

Cited by 43 publications

References 43 publications

Left Ventricular Twist and Torsion

Left Ventricular Twist and Torsion

Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies

Progressive and biphasic cardiac responses during extreme mountain ultramarathon

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