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The International Journal of Cardiovascular Imaging

, Volume 34, Issue 12, pp 1869–1875 | Cite as

Myocardial deformation and volume of exercise: a new overlap between pathology and athlete’s heart?

  • Hélder DoresEmail author
  • Lígia Mendes
  • Paulo Dinis
  • Nuno Cardim
  • José Carlos Monge
  • José Ferreira Santos
Original paper

Abstract

Regular physical exercise induces cardiac adaptations that can overlap pathological conditions. Controversy still persists about the variability of myocardial deformation in different types and intensity of exercise. The aim of this study was to assess myocardial longitudinal deformation in athletes with different level of exercise. Two groups of young athletes involved in endurance sports characterized by high intensity dynamic component were enrolled. According to the level and the number of exercise training hours/week, two groups were defined: Group 1—high level (national/international and ≥ 20 training-hours/week; N = 60); Group 2—low level (recreational/regional and < 10 training-hours/week; N = 48). A comprehensive transthoracic echocardiogram including evaluation of global longitudinal strain (GLS) assessed by 2D speckle-tracking was performed. Athletes in Group 1 showed more pronounced cardiac remodeling and enhanced diastolic function. No significant differences were evident in left ventricle ejection fraction (LVEF) between groups. Overall, GLS (absolute values) was 18.0 ± 2.5%, but significantly lower in Group 1 compared to Group 2 (17.3 ± 2.6% vs. 18.9 ± 2.1%; p = 0.001). Thirty-three (31%) athletes had GLS below 17%, more frequently in Group 1 (79% vs. 45%; p = 0.001), with higher LV and left atrium volumes, lower E wave and A wave peak velocities and E/e′ ratio. In a multivariate analysis to belong to Group 1 was the only independent variable associated with GLS < 17% (OR 6.5; 95% CI 2.4–17.4; p < 0.001). The athletes with a GLS < 17% were all men, more frequently involved in high level exercise, with higher chamber volumes and lower E/e′ ratio. Left ventricular global myocardial longitudinal deformation evaluated by GLS was significantly lower in athletes with higher level of exercise. Although GLS in athletes overlap several pathological conditions, these lower values are associated with an enhanced diastolic performance that allows discrimination between physiologic adaptations and pathology.

Keywords

Exercise training Athletes Myocardial deformation Global longitudinal strain 

Notes

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

References

  1. 1.
    Dores H, Freitas A, Malhotra A, Mendes M, Sharma S (2015) The hearts of competitive athletes: an up-to-date overview of exercise-induced cardiac adaptations. Rev Port Cardiol 34:51–64CrossRefGoogle Scholar
  2. 2.
    Chandra N, Bastiaenen R, Papadakis M, Sharma S (2013) Sudden cardiac death in young athletes: practical challenges and diagnostic dilemmas. J Am Coll Cardiol 61:1027–1040CrossRefGoogle Scholar
  3. 3.
    Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE (2000) The athlete’s heart: a meta-analysis of cardiac structure and function. Circulation 101:336–344CrossRefGoogle Scholar
  4. 4.
    Scott J, Warburton DER (2008) Mechanisms underpinning exercise-induced changes in left ventricular function. Med Sci Sports Exerc 40:1400–1407CrossRefGoogle Scholar
  5. 5.
    Scharhag J, Schneider G, Urhausen A, Rochette V, Kramann B, Kindermann W (2002) Athlete’s heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. J Am Coll Cardiol 40:1856–1863CrossRefGoogle Scholar
  6. 6.
    Scharf M, Brem MH, Wilhelm M, Schoepf UJ, Uder M, Lell MM (2010) Cardiac magnetic resonance assessment of left and right ventricular morphologic and functional adaptations in professional soccer players. Am Heart J 159:911–918CrossRefGoogle Scholar
  7. 7.
    Kovacs A, Apor A, Nagy A, Vagó H, Tóth A, Nagy AI et al (2014) Left ventricular untwisting in athlete’s heart: key role in early diastolic filling? Int J Sports Med 35:259–264PubMedGoogle Scholar
  8. 8.
    Shah AM, Solomon SD (2012) Myocardial deformation imaging: current status and future directions. Circulation 125:e244–e248CrossRefGoogle Scholar
  9. 9.
    Butz T, van Buuren F, Mellwig KP, Langer C, Plehn G, Meissner A et al (2011) Two-dimensional strain analysis of the global and regional myocardial function for the differentiation of pathologic and physiologic left ventricular hypertrophy: a study in athletes and in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 27:91–100CrossRefGoogle Scholar
  10. 10.
    Saghir M, Areces M, Makan M (2007) Strain rate imaging differentiates hypertensive cardiac hypertrophy from physiologic cardiac hypertrophy (athlete’s heart). J Am Soc Echocardiogr 20:151–157CrossRefGoogle Scholar
  11. 11.
    Caselli S, Montesanti D, Autore C, Di Paolo FM, Pisicchio C, Squeo MR et al (2015) Patterns of left ventricular longitudinal strain and strain rate in olympic athletes. J Am Soc Echocardiogr 28:245–253CrossRefGoogle Scholar
  12. 12.
    D’Andrea A, Cocchia R, Riegler L, Scarafile R, Salerno G, Gravino R et al (2010) Left ventricular myocardial velocities and deformation indexes in toplevel athletes. J Am Soc Echocardiogr 23:1281–1288CrossRefGoogle Scholar
  13. 13.
    D’Ascenzi F, Solari M, Mazzolai M, Cameli M, Lisi M, Andrei V et al (2016) Two-dimensional and three-dimensional left ventricular deformation analysis: a study in competitive athletes. Int J Cardiovasc Imaging 32:1697–1705CrossRefGoogle Scholar
  14. 14.
    Richand V, Lafitte S, Reant P, Serri K, Lafitte M, Brette S et al (2007) An ultrasound speckle tracking (two-dimensional strain) analysis of myocardial deformation in professional soccer players compared with healthy subjects and hypertrophic cardiomyopathy. Am J Cardiol 100:128–132CrossRefGoogle Scholar
  15. 15.
    Maufrais C, Schuster I, Doucende G, Vitiello D, Rupp T, Dauzat M et al (2014) Endurance training minimizes age-related changes of left ventricular twist–untwist mechanics. J Am Soc Echocardiogr 27:1208–1215CrossRefGoogle Scholar
  16. 16.
    Baggish AL, Yared K, Weiner RB, Wang F, Demes R, Picard MH et al (2010) Differences in cardiac parameters among elite rowers and subelite rowers. Med Sci Sports Exerc 42:1215–1220PubMedGoogle Scholar
  17. 17.
    Szauder I, Kovacs A, Pavlik G (2015) Comparison of left ventricular mechanics in runners versus bodybuilders using speckle tracking echocardiography. Cardiovasc Ultrasound 13:7CrossRefGoogle Scholar
  18. 18.
    Levine BD, Baggish AL, Kovacs RJ, Link MS, Maron MS, Mitchell JH (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 1: classification of sports: dynamic, static, and impact: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2350–2355CrossRefGoogle Scholar
  19. 19.
    Lang RM, Badano LP, Victor Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270CrossRefGoogle Scholar
  20. 20.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310CrossRefGoogle Scholar
  21. 21.
    Baggish AL, Yared K, Wang F, Weiner RB, Hutter AM Jr, Piccard MH et al (2008) The impact of endurance exercise training on left ventricular systolic mechanics. Am J Physiol Heart Circ Physiol 295:H1109–H1116CrossRefGoogle Scholar
  22. 22.
    Lo Iudice F, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A et al (2017) Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation. Eur Heart J Cardiovasc Imaging 18:549–555PubMedGoogle Scholar
  23. 23.
    Finocchiaro G, Dhutia H, D’Silva A, Malhotra A, Sheikh N, Narain R et al (2018) Role of doppler diastolic parameters in differentiating physiological left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Soc Echocardiogr 31:606–613CrossRefGoogle Scholar
  24. 24.
    Beaumont A, Grace F, Richards J, Hough J, Oxborough D, Sculthorpe N (2017) Left ventricular speckle tracking-derived cardiac strain and cardiac twist mechanics in athletes: a systematic review and meta-analysis of controlled studies. Sports Med 47:1145–1170CrossRefGoogle Scholar
  25. 25.
    Santoro A, Alvino F, Antonelli G, Caputo M, Padeletti M, Lisi M et al (2014) Endurance and strength athlete’s heart: analysis of myocardial deformation by speckle tracking echocardiography. Cardiovasc Ultrasound 22:196–204CrossRefGoogle Scholar
  26. 26.
    Charfeddine S, Mallek S, Triki F, Hammami R, Abid D, Abid L et al (2016) Echocardiographic analysis of the left ventricular function in young athletes: a focus on speckle tracking imaging. Pan Afr Med J 25:171CrossRefGoogle Scholar
  27. 27.
    Simsek Z, Hakan Tas M, Degirmenci H, Gokhan Yazıcı A, Ipek E, Duman H et al (2013) Speckle tracking echocardiographic analysis of left ventricular systolic and diastolic functions of young elite athletes with eccentric and concentric type of cardiac remodeling. Echocardiography 30:1202–1208CrossRefGoogle Scholar
  28. 28.
    Burns AT, La Gerche A, D’hooge J, MacIsaac AI, Prior DL (2010) Left ventricular strain and strain rate: characterization of the effect of load in human subjects. Eur J Echocardiogr 11:283–289CrossRefGoogle Scholar
  29. 29.
    Galderisi M, Lomoriello VS, Santoro A, Esposito R, Olibet M, Raia R et al (2010) Differences of myocardial systolic deformation and correlates of diastolic function in competitive rowers and young hypertensives: a speckle-tracking echocardiography study. J Am Soc Echocardiogr 23:1190–1198CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Armed Forces HospitalLisbonPortugal
  2. 2.Lisbon Luz HospitalLisbonPortugal
  3. 3.NOVA Medical SchoolLisbonPortugal
  4. 4.Chronic Diseases Research Center (CEDOC)LisbonPortugal
  5. 5.Setúbal Luz HospitalSetúbalPortugal
  6. 6.Coimbra Military Health CenterCoimbraPortugal
  7. 7.LisbonPortugal

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