Patterns of Left Ventricular Diastolic Function in Olympic Athletes

Caselli, Stefano; Paolo, Fernando M. Di; Pisicchio, Cataldo; Pandian, Natesa G.; Pelliccia, Antonio

doi:10.1016/j.echo.2014.09.013

Cited by 69 publications

(53 citation statements)

References 52 publications

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“…Due to the significant proportion of untwist that occurs during the IVRT (~50 to 70%) [13], parameters reflecting the earliest phases of relaxation may be considered more sensitive markers of diastolic function when distinguishing trained and untrained populations. Athletes often have normal or superior global diastolic function as measured using conventional markers such as the E, A, and E/A ratio [22, 93]. These observations may be underpinned by early untwisting, allowing the generation of a sufficient pressure gradient and, thus, measurements of untwisting mechanics before mitral inflow may provide a precursor to the traditional well-established parameters.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…It is more complicated when debate comes to the point of LA function. Namely, LA function determines diastole, which has the key role in athletes . Nevertheless, the assessment of LA function is not an easy task because it does not represent evaluation of only one parameter, but the whole set of parameters (total, passive, and active emptying fractions) that resemble LA reservoir, conduit, and active function, respectively .…”

Section: Introductionmentioning

confidence: 99%

Left atrial function in elite athletes: A meta‐analysis of two‐dimensional speckle tracking echocardiographic studies

Cuspidi

Tadić²,

Sala

et al. 2019

Clinical Cardiology

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Background: We sought to investigate left atrial (LA) volume, function, and strain in elite athletes by a meta-analysis including echocardiographic studies that provided volumetric and strain analysis of LA phasic function. Methods:The OVID-MEDLINE, PubMed, and Cochrane CENTRAL databases were searched for English-language articles without time restriction up to February 2018 through focused and high sensitive search strategies. Studies were identified by crossing the following search terms:Results: Meta-analysis included 403 athletes and 314 active but not trained healthy controls from 9 studies. Pooled data showed that average LA volume index was higher in athletes than in healthy controls (28.0 ± 1.0 vs 20.7 ± 0.8 mL/m 2 , P < 0.001). Global LA longitudinal strain, showing LA reservoir function, was lower in the athletes than in healthy controls with borderline significance (37.0 ± 1.2 vs 38.3 ± 1.5%, P = 0.044). Late diastolic LA strain rate, resembling LA contractile function, was also lower in elite athletes than in control group (−1.56 ± 0.08 vs −1.74 ± 0.09 seconds −1, P = 0.007). Conclusions:Our meta-analysis shows that LA volume is higher, while LA reservoir and contractile functions are impaired in elite athletes during active training compared to untrained controls. Whether these changes persist during deconditioning periods remains to be determined. These alterations may be related to the higher risk of arrhythmias, in particular atrial fibrillation, reported among middle/old aged athletes. K E Y W O R D Sleft atrium, meta-analysis, phasic function, strain, volume

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“…39 While none of our volunteers had clinical heart failure, the analogy is that augmented preload due to immersion in cold water a slightly greater left ventricular wall stiffness in SIPE-susceptible individuals could be the cause of higher LV filling pressure during exercise in cold water. Small increases in E/A and E/e′ ratios in extremely fit athletes have been attributed to LV remodeling due to prolonged exercise, 40 and indeed seven of the 10 SIPE-susceptible subjects in this study were extremely physically fit. It has been proposed that increased arterial stiffness may predispose to diastolic dysfunction, especially among women.…”

Section: Discussionmentioning

confidence: 57%

Swimming-Induced Pulmonary Edema

et al. 2016

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Background Swimming-induced pulmonary edema (SIPE) occurs during swimming or scuba diving, often in young individuals with no predisposing conditions, and its pathophysiology is poorly understood. This study tested the hypothesis that pulmonary artery and pulmonary artery wedge pressures are higher in SIPE-susceptible individuals during submerged exercise compared to the general population and are reduced by sildenafil. Methods and Results Ten study subjects with a history of SIPE (mean age 41.6 years) and 20 control subjects (mean age 36.2 years) were instrumented with radial artery and pulmonary artery catheters and performed moderate cycle ergometer exercise for 6–7 minutes while submersed in 20°C water. SIPE-susceptible subjects repeated the exercise 150 minutes after oral administration of 50 mg sildenafil. Work rate and mean arterial pressure during exercise were similar in controls and SIPE-susceptibles. Average VO2 and cardiac output (CO) in SIPE-susceptibles and controls were: VO2 2.42 L.min−1 vs. 1.95 L.min−1, P=0.2; CO 17.9 L.min−1 vs. 13.8 L.min−1, P=0.01). Accounting for differences in CO between groups, mean pulmonary artery pressure (MPAP) at CO=13.8 L.min−1 was 22.5 mmHg in controls vs. 34.0 mmHg in SIPE-susceptibles (P=0.004) and the corresponding pulmonary artery wedge pressure (PAWP) 11.0 mmHg vs. 18.8 mmHg (P=0.028). After sildenafil, there were no statistically significant differences in MPAP or PAWP between SIPE-susceptibles and controls. Conclusions These observations confirm that SIPE is a form of hemodynamic pulmonary edema. The reduction in pulmonary vascular pressures after sildenafil with no adverse effect on exercise hemodynamics suggests that it may be useful in SIPE prevention. Clinical Trial Registration Information ClinicalTrials.gov. Identifier: NCT00815646.

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Patterns of Left Ventricular Diastolic Function in Olympic Athletes

Cited by 69 publications

References 52 publications

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

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

Left atrial function in elite athletes: A meta‐analysis of two‐dimensional speckle tracking echocardiographic studies

Swimming-Induced Pulmonary Edema

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