MethodsPulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and myocardial regional diastolic function
Section snippets
Study group
We enrolled 20 highly competitive, male water polo players, who had been trained intensively 15 to 20 hours/week for >5 years, and 20 untrained healthy men. The training protocol included 3 hours/day of aerobic isotonic dynamic exercise at incremental workloads of 70% to 100% of maximal HR, and only 1-hour/week of isometric static exercise at 30% of maximal workload. Subjects were excluded for coronary artery disease, valvular and congenital heart disease, heart failure, cardiomyopathy,
Clinical characteristics of study group
The 2 groups were comparable for age (22.5 ± 5.3 years in controls and 19.7 ± 3.7 years in athletes), body surface area (BSA) (1.82 ± 0.15 and 1.86 ± 0.07 m2, respectively) and BP (125.1 ± 9.8/73.8 ± 7.2 and 115.0 ± 14.7/70.5 ± 5.6 mm Hg). As expected, HR was lower in the athletes (65.6 ± 3.9 vs 75.1 ± 9.4 beats/min, p <0.001).
Standard Doppler echocardiographic analysis (Table I)
Athletes had greater endocardial fractional shortening (p <0.05) and stroke volume (p <0.01), higher peak velocity E/A ratio (p <0.02), and greater LV mass index (p
Discussion
This study underscores the usefulness of DTI to identify myocardial diastolic properties of the trained heart. Endurance athletes have (1) greater inferior Em peak velocity than controls, (2) greater septal and inferior Em/Am ratio, and (3) longer myocardial DTm in both walls. Finally, and most important, in the overall population, the difference in Em/Am ratio and myocardial diastolic times are explained by HR changes, but Em peak velocity is directly and independently associated with LVIDD.
References (29)
Structural features of the athlete heart as defined by echocardiography
J Am Coll Cardiol
(1986)- et al.
Different effects of prolonged exercise on the right and left ventricles
J Am Coll Cardiol
(1990) - et al.
Noninvasive evaluation of world class athletes engaged in different modes of training
Am J Cardiol
(1989) - et al.
Morphology of the “athlete’s heart” assessed by echocardiography in 947 elites athletes representing 27 sports
Am J Cardiol
(1994) - et al.
Comparison of left ventricular function using isometric exercise Doppler echocardiography in competitive runners and weightlifters versus sedentary individuals
Am J Cardiol
(1997) - et al.
Colour Doppler velocity imaging of the myocardium
Ultrasound Med Biol
(1992) - et al.
Quantitative Doppler tissue imaging of left ventricular myocardiumvalidation in normal subjects
Am Heart J
(1995) - et al.
Differentiation of constrictive pericarditis from restrictive cardiomyopathyassessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging
J Am Coll Cardiol
(1996) - et al.
Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic cardiomyopathy
Am J Cardiol
(1998) - et al.
Left ventricular mass and body size in normotensive children and adultsassessment of allometric relations and impact of overweight
J Am Coll Cardiol
(1992)
Physiological hypertrophyeffects on left ventricular systolic mechanics in humans
J Am Coll Cardiol
Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy
J Am Coll Cardiol
Impact of heart rate and PR interval on Doppler indexes of diastolic filling in an elderly cohort (the Framingham Heart Study)
Am J Cardiol
Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function
J Am Coll Cardiol
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2015, Journal of the American Society of EchocardiographyCitation Excerpt :Since then, Doppler-derived parameters of transmitral filling and myocardial relaxation have become an important part of the routine echocardiographic assessment in athletes. 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.12-20,35-37 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.11,21-25,35