Cardiac tissue Doppler imaging in sports medicine

The differentiation of training-induced cardiac adaptations from pathological conditions is a key issue in sports cardiology. As morphological features do not allow for a clear delineation of early stages of relevant pathologies, the echocardiographic evaluation of left ventricular function is the technique of first choice in this regard.Tissue Doppler imaging (TDI) is a relatively recent method for the assessment of cardiac function that provides direct, local measurements of myocardial velocities throughout the cardiac cycle. Although it has shown a superior sensitivity in the detection of ventricular dysfunction in clinical and experimental studies, its application in sports medicine is still rare. Besides technical factors, this may be due to a lack in consensus on the characteristics of ventricular function in relevant conditions.For more than two decades there has been an ongoing debate on the existence of a supernormal left ventricular function in athlete's heart. While results from traditional echocardiography are conflicting, TDI studies established an improved diastolic function in endurance-trained athletes with athlete's heart compared with controls.The influence of anabolic steroids on cardiac function also has been investigated by standard echocardiographic techniques with inconsistent results. The only TDI study dealing with this topic demonstrated a significantly impaired diastolic function in bodybuilders with long-term abuse of anabolic steroids compared with strength-trained athletes without abuse of anabolic steroids and controls, respectively.Hypertrophic cardiomyopathy is the most frequent cause of sudden death in young athletes. However, in its early stages, it is difficult to distinguish from athlete's heart. By means of TDI, ventricular dysfunction in hypertrophic cardiomyopathy can be disclosed even before the development of left ventricular hypertrophy. Also, a differentiation of left ventricular hypertrophy due to hypertrophic cardiomyopathy or systemic hypertension is possible by TDI.Besides the evaluation of different forms of left ventricular hypertrophy, the diagnosis of myocarditis is also of particular importance in athletes. Today, it still requires myocardial biopsy. The analysis of focal disturbances in myocardial velocities might be a promising non-invasive method; however, systematic validation studies are lacking.An important future issue for the implementation of TDI into routine examination will be the standardisation of procedures and the establishment of significant reference values for the above-mentioned conditions. Innovative TDI parameters also merit further investigation.     

Strain rate and tissue tracking imaging in quantitation of left ventricular systolic function in endurance and strength athletes

AIM: The aim of this study was to assess the impact of long-term physical training on left ventricular longitudinal contraction by strain rate analysis and tissue tracking imaging. METHODS AND RESULTS: The study population comprised 17 male elite endurance and 15 male elite strength athletes and 12 male control subjects of similar age. Tissue Doppler imaging was recorded in the apical views and used for analysis of the longitudinal systolic myocardial velocity, annular diastolic velocities, strain rate and tissue tracking. Left ventricular mass index was significantly increased in both endurance athletes (209+/-40 g/m(2)) and strength athletes (138+/-38 g/m(2)) compared with normal subjects (96+/-20 g/m(2), P<0.001). Tissue tracking score index and mean strain rate of the 16 segments were significantly increased in strength athletes (7.9+/-1.1 mm and -1.4+/-0.3 s(-1), respectively) compared with endurance athletes (7.5+/-0.9 mm and -1.0+/-0.4 s(-1), P<0.01 for both) and normal subjects (7.4+/-1.0 mm and -1.0+/-0.3 s(-1), P<0.01 for both). CONCLUSION: Despite significant left ventricular hypertrophy and extensive training in elite athletes, we found normal longitudinal left ventricular systolic function, and in strength athletes performing isometric exercise even increased function.     

Effects of anabolic-androgenic steroids on weight-lifters' myocardium: an ultrasonic videodensitometric study

BACKGROUND: Recent bioptical data have shown that in weight-lifters (WL) under the pharmacological effects of anabolic-androgenic steroids (AAS), a focal increase in myocardial collagen content might occur as a reparative mechanism against a myocardial damage. OBJECTIVE: The aim of this study was to investigate whether by using videodensitometry an early identification of the changes in myocardial texture is possible or a potential sign of myocardial damage, which can potentially occur in WL who have used AAS. METHODS: Ten males WL (mean age: 32+/-6 yr) who had regularly used AAS (users), were compared with 10 male WL at same training level (nonusers), who had not used any drugs and with 10 healthy sedentary controls (controls). The three groups were age and sex-matched. Echocardiographic parietal, septal thickness, and left ventricular mass (LVMbs) were evaluated. Left ventricular systolic and diastolic functions were evaluated with Doppler examination. Quantitative analysis of echocardiographic digitized data was carried out with a calibrated 256 gray level digitization system, in order to calculate the mid-septum and the mid-posterior mean gray level (MGL) and to derive the cyclic variation index (CVI), i.e., the percent MGL variation during cardiac cycle. RESULTS: The weight and relative body mass index were significantly higher in WL (P<0.001); also the diastolic blood pressure was slightly but significantly higher in users in comparison both with nonusers and controls (P<0.01). Systolic and diastolic functional parameters overlapped in the three groups. LVMbs was significantly higher in users (145+/-17) and in nonusers (122+/-27) vs. C (104+/-18 g x m(-2)) (p<0.001). CVI at septum level showed significant differences: users: (2.3+/-31%) vs nonusers: (23+/-8) and controls (29+/-5) (P<0.005); although no significant difference was found between nonusers and controls. CVI at posterior wall level followed a similar pattern. No relationship was found between CVI and LVMbs or wall thickness. DISCUSSION: As brought out by videodensitometry, despite an increase in septal and parietal thickness and consequently in LVMbs, the physiological pressure overload that happens in WL during sport activities, in absence of any drugs, does not modify the myocardial ultrasonic texture. The abuse of AAS in WL, on the other hand, determines some alterations of the myocardial textural parameters. The real significance of these changes of myocardial texture detected with videodensitometry in WL who use anabolic-androgenic steroids, present also in the absence of other systolic and diastolic left ventricular functional indexes alterations, needs to be further explored with a larger population through the comparison with endobioptical data and with a follow-up study approach.     

Left ventricular structure and function, assessed by imaging and Doppler echocardiography, in athletes engaged in throwing events

Ten male athletes engaged in throwing events and ten control subjects, matched for age, height, and weight, were investigated with echocardiography and Doppler velocimetry to assess cardiac structure and systolic and diastolic left ventricular function at rest. Left ventricular (LV) internal diameter, wall thickness, LV mass, and systolic LV function were not different between athletes and nonathletes. The possibility that strength training could alter LV diastolic function was further investigated. Both early diastolic function, estimated from the velocity of LV relaxation and the LV inflow pattern, and late diastolic function, assessed by Doppler velocimetry, were similar in throwers and controls. The unchanged ratio of the peak velocities of LV filing during atrial contraction and early filling suggests that LV distensibility is unaltered in these athletes. In conclusion, the amount and type of training performed by these throwers was not associated with changes in LV structure and function.     

Left ventricular wall motion during diastolic filling in endurance-trained athletes

PURPOSE: The purpose of this study was to assess left ventricular (LV) wall motion in highly endurance-trained athletes to evaluate LV diastolic function in physiologically hypertrophied hearts. BACKGROUND: Diastolic filling dynamics have previously been examined in endurance-trained athletes by measuring pulsed-wave mitral inflow velocities during the early and atrial filling phase, indicating an unimpaired LV function. Assessment of LV wall motion may give additional information about the LV diastolic function in endurance-trained athletes. METHODS: Left ventricular mass (LVM) and volume (LVV) were determined by M-mode echocardiography. Peak LV wall motion in the region of the basal septum close to the mitral anulus were measured during the early rapid and atrial filling phase by tissue Doppler in 30 endurance-trained athletes (T) and 16 sedentary control subjects (C) presumed to be healthy. Results: Myocardial LVM and LVV in T (LVM 159.4 +/- 18.0 g.m(-2), LVV 100.4 +/- 13.0 mL.m(-2)) were significantly higher than in C (LVM 105.7 +/- 12.0.m(-2), LVV 70.1 +/- 11.9 mL.m(-2)), and heart rate (HR) was significantly lower (HR C: 69.6 +/- 11.0 bpm, T 50.9 +/- 8.7 bpm),which is consistent with endurance training (P < 0.01 for both). Peak LV wall motion during the early rapid filling phase did not differ significantly between the groups (T: 10.69 +/- 1.46 cm.(s-)1; C: 10.61 +/- 1.52 cm.(s-)1). Peak atrial wall motion was significantly lower in T (4.53 +/- 0.84 cm.s-1) versus C (5.74 +/- 0.75 cm.s(-1)), and the ratio of peak early diastolic to atrial wall motion was consequently higher in athletes (P < 0.01 for both). Conclusion: Regional wall motion at the basal septum near the mitral anulus during the early rapid filling phase is not altered by an increase in LVM or LVV when associated with endurance training.     

Left ventricular function and perfusion in elderly endurance athletes

PURPOSE: To study the extent to which lifelong physical training can affect cardiovascular capacity, left ventricular function, and myocardial perfusion in elderly men. METHODS AND RESULTS: Ten healthy male veteran endurance athletes aged 73 +/- 3 yr (mean +/- SD) and a control group of 12 sedentary or moderately physically active healthy subjects aged 75 +/- 2 yr were studied. Echocardiographic examinations at rest and exercise stress tests were performed. Gated blood pool scans and myocardial perfusion scintigraphy were recorded at rest and during exercise. Maximal VO2 was 41 +/- 7 mL.kg-1.min-1 in the athletes and 26 +/- 5 mL.kg-1.min-1 in the controls (P < 0.001). Echocardiographic measures of systolic and diastolic function at rest were better in the athletes. The ejection fraction during exercise was also higher in the athletes (P = 0.003). Seven of the 10 athletes, but none of the controls, had pathological myocardial perfusion findings. CONCLUSIONS: By endurance training, a high level of physical capacity can be maintained late in life. The superior cardiovascular function in the veteran athletes, compared with the untrained controls was due to both better systolic and diastolic left ventricular function. Myocardial perfusion defects in athletes should be judged with caution, as this finding is common both in veteran athletes and as previously shown, in young athletes.     

Aortic distensibility and left ventricular diastolic functions in endurance athletes

Aortic elastic properties are important determinants of left ventricular function. The aim of this study was to determine left ventricular diastolic function and aortic distensibility in endurance athletes. Thirty male runners and thirty age-matched healthy male controls took part in the study. All subjects underwent echocardiographic examination and cardiopulmonary exercise testing. Measurements included LV cavity dimension, standard and tissue Doppler parameters, and aortic diameter, 3 cm above aortic valve, at systole and diastole. Maximal oxygen uptake in athletes was higher than in controls. The aortic distensibility index was found to be higher in athletes compared with controls (5.37 +/- 1.50 vs. 3.37 +/- 1.48 cm (2) . dynes (-1) . 10 (-6), p < 0.001). While the aortic stiffness index in athletes was significantly lower than in controls (2.77 +/- 0.28 vs. 3.43 +/- 0.41, p < 0.001). Furthermore, transmitral early peak velocity (E) and late peak velocity (A), peak velocity of myocardial systolic wave (S (m)), early (E (m)) and atrial (A (m)) diastolic waves in athletes were higher than in controls. It seemed that the association of E (m) velocity with aortic distensibility was stronger than that of other LV parameters (coefficient = 0.74, p < 0.001) by using multiple linear regression. Increased aortic distensibility in endurance-trained athletes may cause better diastolic function as a physiological cardiovascular adaptation factor.     

Athlete's heart in postmenopausal former elite endurance female athletes.

OBJECTIVE: To investigate cardiac structure and function and exercise capacity in senior former elite athlete women. DESIGN: Cross-sectional study. PARTICIPANTS: Twenty postmenopausal former elite endurance athletes and 19 age-matched sedentary controls. METHODS: All subjects underwent transthoracic Doppler echocardiography and maximal exercise test on a bicycle ergometer. MAIN OUTCOME MEASURES: Cardiac chamber dimensions, wall thickness, cardiac function, and exercise capacity. RESULTS: The athletes had a greater exercise capacity (183 +/- 26 vs. 144 +/- 36 W; P < 0.01) compared with controls. Three of 20 (15%) athletes and 9 of 19 (47%) controls exhibited ST depressions during exercise test (P < 0.05). Echocardiographic measurements demonstrated larger left ventricular diameter (2.9 +/- 0.3 vs. 2.6 +/- 0.2 cm/m; P < 0.01), left ventricular volume (64 +/- 14 vs. 54 +/- 8 mL/m; P < 0.05), right ventricular diameter (1.6 +/- 0.2 vs. 1.4 +/- 0.2 cm/m; P < 0.01), left atrial volume (20.8 +/- 6 vs. 16.6 +/- 3.6 mL/m; P < 0.05), and stroke volume (45 +/- 10 vs. 36 +/- 5 mL/m; P < 0.01) in athletes than controls, whereas interventricular septum (9.3 +/- 1.7 vs. 10.1 +/- 1.8 mm; P > 0.05) and posterior wall thickness (9.0 +/- 1.6 vs. 9.2 +/- 1.0 mm; P > 0.05) did not differ between the groups. CONCLUSIONS: This study demonstrates cardiac enlargement without increased wall thickness in postmenopausal former elite endurance athlete women. Our results also indicate that long-term training maintains a high level of cardiovascular fitness in the aging female athletes.     

Echocardiographic evaluation of left ventricular diastolic function in patients with aortic valve stenosis

Impairment of left ventricular diastolic function in aortic valve stenosis occurs very early and precedes the impairment of systolic function. Aim was to examine left ventricular diastolic function and its association with severity of myocardial hypertrophy and clinical picture. The paper comprised 78 patients with isolated aortic valve stenosis in whom were performed ultrasonography and catheterization. No significant differences in parameters of diastolic filling were observed in patients with mild hypertrophy and preserved systolic function compared to healthy subjects. In patients with moderate myocardial hypertrophy, left ventricular filling was decreased in an early diastole (Emax 51 +/- 5 cm/s, Evti 6.4 +/- 1.1 cm) and increased in late diastole (Amax 88 +/- 11 cm/s, Avti 11.4 +/- 1.8 cm), while deceleration time was prolonged (DT 171 +/- 32 ms). Pulmonary vein flow was decreased during diastole (Dmax 33 +/- 5 cm/s, Dvti 7.6 +/- 2 cm). Pseudonormalization of flow through mitral valve was observed in patients with pronounced hypertrophy of left ventricular wall (mass > 180 g/m2): increase of the velocity during the phase of fast left ventricular filling (Emax 72 +/- 13 cm/s, Evti 9.8 +/- 2.1 cm), decrease during atrial contraction (Amax 31 +/- 6 cm/s, Avti 3.7 +/- 0.4 cm), reduction in deceleration time (DT 116 +/- 11 ms), while pulmonary vein flow velocity was increased during the early diastole (Dmax 64 +/- 17 cm/s, Dvti 10.7 +/- 2.2 cm). Likewise, significant correlation between clinical picture and type of blood flow through mitral valve was observed.     

Prospective echocardiographic assessment of androgenic-anabolic steroids effects on cardiac structure and function in strength athletes

Since the abuse of androgenic-anabolic steroids (AAS) has been associated with the occurrence of serious cardiovascular disease in young athletes, we performed two studies to investigate the effects of short-term AAS administration on heart structure and function in experienced male strength athletes, with special reference to dose and duration of drug abuse. In Study 1 the effects of AAS were assessed in 17 experienced male strength athletes (age 31 +/- 7 y) who self-administered AAS for 8 or 12 - 16 weeks and in 15 non-using strength athletes (age 33 +/- 5 y) in a non-blinded design. In Study 2 the effects of administration of nandrolone decanoate (200 mg/wk i. m.) for eight weeks were investigated in 16 bodybuilders in a randomised double blind, placebo controlled design. In all subjects M-mode and two-dimensional Doppler-echocardiography were performed at baseline and after 8 weeks AAS administration. In the athletes of Study 1 who used AAS for 12 - 16 weeks a third echocardiogram was also made at the end of the AAS administration period. Echocardiographic examinations included the determination of the aortic diameter (AD), left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), interventricular septum thickness (IVS), posterior wall end diastolic wall thickness (PWEDWT), left ventricular mass (LVM), left ventricular mass index (LVMI), ejection fraction (EF) and right ventricular diameter (RVD). For assessment of the diastolic function measurements of E and A peak velocities and calculation of E/A ratio were used. In addition, acceleration and deceleration times of the E-top (ATM and DT, respectively) were determined. For evaluation of factors associated with stroke volume the aorta peak flow (AV) and left ventricular ejection times (LVET) were determined. In Study 1 eight weeks AAS self-administration did not result in changes of blood pressure or cardiac size and function. Additionally, duration of AAS self-administration did not have any impact on these parameters. Study 2 revealed that eight weeks administration of nandrolone decanoate did not induce significant alterations in blood pressure and heart morphology and function. Short-term administration of AAS for periods up to 16 weeks did not lead to detectable echocardiographic alterations of heart morphology and systolic and diastolic function in experienced strength athletes. The administration regimen used nor the length of AAS abuse did influence the results. Moreover, it is concluded that echocardiographic evaluation may provide incomplete assessment of the actual cardiac condition in AAS users since it is not sensitive enough to detect alterations at the cellular level. Nevertheless, from the present study no conclusions can be drawn of the cardiotoxic effects of long term AAS abuse.     

Impact of repeated prolonged exercise bouts on cardiac function and biomarkers

PURPOSE: The present study examined the impact of repeated bouts of prolonged (< 60 min) exercise on left ventricular function and cardiac biomarkers. METHODS: Ten athletes completed a 15.3-mile hill run on three consecutive days and were assessed before, immediately after, 1 h after, and 20 h after each bout. Six of the athletes completed a fourth bout. Left ventricular (LV) function was examined echocardiographically using two-dimensional M-mode, Doppler, and flow propagation velocity (Vp). Venous blood samples were analyzed for cardiac biomarkers including cardiac troponin T (cTnT). RESULTS: Ejection fraction (EF) significantly decreased (P = 0.027) after the third exercise bout compared with baseline (mean +/- SD: 56.3 +/- 4.4 vs 51.3 +/- 5.9%), accompanied by a nonsignificant decrease in systolic blood pressure/end systolic volume (SBP/ESV) ratio. A sustained depression in systolic function 20 h after bout 3 also persisted in the subset who completed a fourth bout, yet this did not reach clinical levels. Significant (P < 0.01) reductions in early to late diastolic filling (E:A) ratio pre-to post-bout 1 (mean +/- SD: 1.9 +/- 0.5 vs 1.4 +/- 0.3) and pre- to post-bout 3(2.0 +/- 0.5 vs 1.3 +/- 0.4) normalized after each 20-h recovery period. A similar pattern of change was observed in Vp. Cardiac troponin T was elevated in four individuals 1 h after bout 1 (range: 0.013-0.125 microg.L(-1)) but was undetectable thereafter except in one athlete. CONCLUSION: Repeated bouts of prolonged exercise induce short-term reductions in diastolic filling and a cumulative decrease in systolic function, yet these alterations seem to have minimal clinical or functional impact. Elevated cTnT after the initial bout, but not thereafter, may represent an adaptive response to prolonged exercise.     

Anabolic steroid use in body builders: an echocardiographic study of left ventricle morphology and function

To ascertain the effect of anabolic steroids (AS) on left ventricle size and function, M-mode and 2D echocardiographic evaluation was carried out in 14 body builders at the end of a phase of AS self-administration (8 +/- 3 weeks, mean +/- S.D.) and after a period (9 +/- 2 weeks, mean +/- S.D.) of drug withdrawal, as well as in 14 other body builders who had never made use of AS, and in 14 sedentary individuals. All the subjects were also examined anthropometrically. Ventricular septal thickness index was slightly greater in athletes using AS, compared to the other two groups (p less than 0.05), while left ventricle mass, the end-diastolic volume indexes and isovolumetric relaxation time, (a parameter of left ventricle diastolic function) were significantly increased (p less than 0.001) as well as the fat free mass (FFM), a marker of skeletal muscle mass. The non-users showed no differences in echocardiographic parameters, compared to sedentary controls. During the off treatment phase, the percentage of adipose mass increased and FFM decreased, while echocardiographic parameters did not vary significantly from on treatment values. The findings indicate that AS can induce an unfavourable enlargement and thickening of the left ventricle, which loses its diastolic properties with the mass increase. These modifications tend to persist following a short period of drug withdrawal.     

组织多普勒成像技术评价冠心病心肌梗死后左室整体功能

 目的 应用超声心动图对冠心病心肌梗死患者进行检测,寻找与左室功能相关性良好的指标以利于临床评估.方法 对经临床及冠状动脉造影确诊的心肌梗死(1～6个月)患者68例行多普勒超声心动图检查.根据其二尖瓣口血流频谱形态将患者分为3组:左室松弛性减低组、假性正常化组、限制性充盈组;又根据心脏射血分数(ejection fraction,EF)值将患者分为两组:EF≥50％,EF＜ 50％,将各多普勒超声心动图参数在各组对比分析.结果 随着心脏舒张功能障碍的进展,运用组织多普勒技术(TDI)测得的二尖瓣环舒张早期峰值速度(Ea)及其与舒张晚期峰值速度(Aa)的比值Ea/Aa降低(P＜0.01),其差别尤其表现在对照组与左室松弛性减低组及其与假性正常化组之间(P＜0.01).在正常对照组、冠心病心肌梗死EF正常组及冠心病心肌梗死EF减低组TDI测得的二尖瓣环收缩期峰值速度Sa、Ea及Ea/Aa比值呈逐渐降低趋势(P＜0.01).而且Spearman相关分析表明:Ea值及Ea/Aa比值与左室舒张功能障碍分级相关性良好,Sa与EF值相关性良好.结论 冠心病心肌梗死患者出现左室舒张功能障碍常先于左室收缩功能障碍,TDI测得的Ea及Ea/Aa比值可用于鉴别左室舒张功能的假性正常化;TD1测得的Sa可作为评估冠心病心肌梗死患者左室收缩功能的重要参数.     

Anabolic androgenic steroids produce dose-dependant increase in left ventricular mass in power atheletes,and this effect is potentiated by concomitant use of growth hormone

Power athletes abuse anabolic androgenic steroids (AASs) and growth hormone (GH) to gain their muscular mass and strength. We wanted to determine how massive, self-administered doses of AASs with or without GH affect the left ventricular (LV) dimensions in power athletes. These substances are assumed to increase LVmass mainly by thickening the ventricular walls. Anecdotal evidence suggests a higher risk of cardiovascular events in AAS abusers. We were interested to see if LV dimensions and function in AAS abusers would indicate this increased risk. Twenty healthy male power athletes using massive doses of AAS without (n = 16) or with (n = 4) GH volunteered for the study. The controls were 15 sedentary male non-users of hormones. LV mass, geometry and filling were studied using standard echocardiographic methods. We found a significant association between LV mass and AAS dose (r = 0.54, p < 0.015). In contrast to the controls, LV mass (274 g in the athletes, 167 g in the controls) among the AAS abusers did not correlate with body weight or height. Concomitant use of AAS and GH further increased LV mass and associated with concentric remodelling of LV. Multiple regression analysis indicated that the mean AAS dose accounted for 29 %, age for 14 % and systolic blood pressure for 17 % of the variance in LV mass. We concluded that AAS abuse associates dose-dependently with myocardial hypertrophy and that concomitant use of GH associates with concentric remodelling of the LV. Our findings suggest that AASs and GH have a direct effect on the myocardium.     

Effects of posture on left ventricular diastolic filling during exercise

BACKGROUND: Measuring the transmitral flow velocity with Doppler echocardiography is a useful method for evaluating left ventricular diastolic function. However, there are few data regarding the effect of posture during exercise on transmitral flow velocity. METHODS: The transmitral flow velocity with pulsed-wave Doppler echocardiography was measured during supine and upright bicycle ergometer exercise in 10 normal young men without cardiac disease (26.7 +/- 5.5 yr). RESULTS: The ratio of the early rapid filling wave to the atrial filling wave (E/A) was gradually decreased with increasing exercise intensity. At rest and during recovery, the E/A ratio was significantly higher (P < 0.01) in the supine position than in the upright position. This difference was caused mainly by the higher E wave in the supine position. However, E wave and E/A ratio did not differ between the upright and supine position during exercise. CONCLUSION: Although measurement of left ventricular filling is completely noninvasive and clinically useful for evaluating diastolic function, it was found that the E/A ratio was profoundly influenced by posture and exercise intensity. These results suggest that the potential influences of posture and exercise intensity on the filling velocities should be taken into account when interpreting diastolic function by Doppler echocardiography.     

Impaired left ventricular diastolic function in athletes after utterly strenuous prolonged exercise

Digitized M mode echocardiography was used to evaluate the effect of a competitive 24-h run on the left ventricular diastolic function in 12 well-trained marathon runners who completed 146-227 km during the race. Mitral valve opening was delayed, early diastolic filling was decreased and prolonged, and posterior wall thinning was reduced, particularly among those athletes completing close to 200 km or more. Since the alterations were in part the opposite in those running 160 km or less, only the reductions in the peak rate of dimension increase (P less than 0.05) and posterior wall thinning (P less than 0.01) were significant in the group as a whole. The delay in mitral valve opening (r = 0.76), the decrease in the peak rate of dimension increase (r = -0.68), and the prolongation of the early diastolic filling period (r = 0.60) were correlated with the distance completed. The reductions in left ventricular end-diastolic dimension and fractional shortening were not in proportion to the distance run, however (r = 0.23 and 0.46, respectively). Measurements made on six athletes 2-3 days after the race showed reversal of the indices of left ventricular diastolic function. Extremely exhaustive prolonged exercise thus appears to result in a marked reversible impairment in left ventricular relaxation and filling. Since the effect of these abnormalities in cardiac filling during exercise is probably more important due to the shorter diastole, the prevention of hypohydration, which could otherwise further compromise left ventricular filling, becomes crucial.     

Tissue Doppler assessment of ventricular function during cycling in 7- to 12-yr-old boys

PURPOSE: Studies utilizing submaximal supine exercise have indicated that tissue Doppler imaging (TDI) may be useful for assessing ventricular systolic and diastolic function during exercise and might offer a means of detecting patients with early myocardial dysfunction. This investigation of 14 healthy boys ages 7-12 yr was designed to assess measures of inotropic and lusitropic function during maximal upright cycle exercise. METHODS: Color tissue Doppler imaging (S and E' waves, indicative of systolic and diastolic function, respectively), stroke volume, and mitral peak inflow velocity (E wave) were recorded at rest and during a progressive upright cycle test to exhaustion. RESULTS: Values of TDI-S and TDI-E' were obtained at exhaustive exercise in all but one subject. Mean value of S rose 163% (3.8+/-1.2 to 10.0+/-2.5 cm.s), and average E' increased by 92% (-6.3+/-2.2 to -12.1+/-3.2 cm.s). No significant changes were observed in the ratio of E' to mitral peak flow velocity (E), suggesting that left ventricular end-diastolic pressure remained stable. CONCLUSIONS: These data indicate that measurement of TDI is feasible during maximal upright exercise, and velocities obtained may provide insights into ventricular systolic and diastolic functional capacity.     

A comparative study of left ventricular structure and function in elite athletes.

Adaptations to left ventricular (LV) structure and function appear to be dependent on the type, intensity and duration of exercise training. We therefore studied two clearly defined groups of elite athletes, by M-mode and Doppler echocardiography, with a group of inactive individuals as controls. All groups were age matched. Group 1 comprised ten elite endurance athletes with maximal oxygen consumption (VO2 max) of 74.7 +/- 1.43 (mean +/- SEM). Group 2 consisted of ten elite weightlifters with VO2 max 45.3 +/- 2.00. Group 3 comprised of ten inactive individuals with VO2 max 44.5 +/- 2.13. Left ventricular end diastolic dimension was significantly higher in group 1 (5.72 +/- 0.07) than in groups 2 or 3 (5.29 +/- 0.09 and 5.19 +/- 0.09 respectively, p less than 0.001). Left ventricular mass index was significantly higher in groups 1 and 2 (156.4 +/- 5.97 and 138.6 +/- 7.27 respectively) than in group 3 (104.1 +/- 3.16 p less than 0.001). Percentage fractional shortening was used as an index of systolic function and no significant difference was found between groups. Doppler E:A ratio was taken as an index of diastolic function and was found to be significantly elevated in group 1 at rest (3.37 +/- 0.24) compared with 2.38 +/- 0.16 and 1.99 +/- 0.10 in groups 2 and 3 respectively (p less than 0.003). On exercise, the E:A ratio in group 1 was significantly higher than in group 3 (1.95 +/- 0.14 and 1.23 +/- 0.05 respectively p less than 0.001), and tended to be higher than group 2 (1.68 +/- 0.15 p = ns). These data show that both modes of intense training produce left ventricular hypertrophy. Diastolic function is not impaired in the athletes and may be augmented in the endurance athletes.     

Physiological cyclic variation of the myocardial integrated backscatter signal in athlete's heart

BACKGROUND: Left ventricular hypertrophy which realizes in athlete's heart could create some problems of acoustic reflection related to the increase of myocytic and not-myocytic elements of the heart. The aim of the present study was to analyze the ultrasonic backscatter myocardial indexes both as peak end-diastolic signal intensity and as its cardiac-cyclic variation in athlete's heart, compared to healthy sedentary controls. METHODS: Two groups of ten subjects each, all males of mean age (31.6+/-3.5), and of comparable weight and height were analyzed: group (A) comprised ten cyclists of good professional level and group (C) included ten healthy subjects acting as controls. A 2D-color Doppler echocardiography with a digital echograph Agilent Technologies (AT) Sonos 5500 was carried out on all subjects in the study for the conventional analysis of the left ventricular mass and function. The ultrasonic myocardial integrated backscatter signal (IBS) was analyzed with an "Acoustic Densitometry" module implemented on an AT echograph. The signal was also sampled with a R.O.I. placed at interventricular septum and at posterior left ventricular wall level. The systo-diastolic variation of the backscatter was also considered as Cyclic Variation Index (CVIibs). RESULTS: The left ventricular mass was significantly higher in athletes in comparison with controls (LVMbs: A: 154.5+/-18.7; C: 101.4+/-12.4; p<0.001). The end diastolic IBS signal did not show significant statistical differences between the two groups. The CVIibs both at septum (A: 30.5+/-5.3; C: 27.2+/-7.3; p<0.002) and posterior wall level (A: 43.7+/-9.1; C: 40.7+/-9.1; p<0.001) though was comparable in both groups. CONCLUSION: The conclusions reached in the present study confirmed the physiology of the left ventricular hypertrophy of the athlete's heart evaluated with an ultrasonic integrated backscatter tissue characterization, in particular through the cyclic variation of integrated backscatter myocardial signal. This finding is probably the expression of a preserved intramural myocardial function in the athlete's heart despite the increase of left ventricular mass induced by physical training.