Supernormal diastolic function and role of left atrial myocardial deformation analysis by 2D speckle tracking echocardiography in elite soccer players

Purpose: Top‐level training is associated with morphological and functional changes in the heart. Left atrial (LA) enlargement can be regarded as a physiologic adaptation to exercise conditioning. Athletes show an improvement in myocardial diastolic properties and supernormal left ventricular (LV) diastolic function. The aims of the study were to assess diastolic function by pulsed Doppler tissue imaging (DTI) and to analyze the role of LA in athletes by speckle tracking echocardiography (STE). Methods: Twenty‐three male elite soccer players underwent a complete echocardiographic analysis. Twenty‐six age‐matched healthy sedentary men were used as controls. Measured variables included LA indexed volumes, DTI of the LV, peak atrial longitudinal strain, and peak atrial contraction strain (PACS). Results: LA areas and indexed volumes were significantly higher in athletes (P < 0.001). Athletes had a higher peak E velocity (P < 0.001), a lower A peak (P < 0.01), and a higher peak E/A ratio (P < 0.0001); a higher Em peak (P < 0.001), a lower Am peak (P < 0.01), and a higher Em/Am ratio (P < 0.0001). Global PACS was lower in athletes compared with controls (P < 0.0001) and strongly correlated with mitral Am (r = 0.55; P < 0.0001), mitral Em (r =?0.41; P < 0.001), heart rate (r =?0.38; P < 0.01), and LA area (r = 0.18; P < 0.05). Conclusions: Athletes showed a shift in the pattern of ventricular filling period toward early diastole as seen through DTI analysis of the diastolic properties of LV and STE analysis of LA function. DTI is a useful tool to analyze the improved myocardial diastolic properties of athletes and STE may elucidate the role of LA in the context of athlete's heart remodeling. (Echocardiography 2011;28:320‐326)     

Five‐year follow‐up two‐dimensional speckle tracking echocardiography in a juvenile with a double‐chambered left ventricle

Double‐chambered left ventricle (DCLV) is a particularly rare congenital entity characterized by the presence of two ventricular cavities separated by an abnormal muscle band. An asymptomatic 15‐year‐old boy was referred to our hospital because of electrocardiographic (ECG) abnormalities. His initial transthoracic echocardiography (TTE) demonstrated a DCLV with mild left ventricular systolic dysfunction. During a 5‐year follow‐up period, he remained symptom free with no changes in ECG and conventional TTE findings. However, two‐dimensional speckle tracking echocardiography revealed a subtle progressive deterioration of left ventricular systolic function during the 5‐year follow‐up.     

Effect of preload on left ventricular longitudinal strain by 2D speckle tracking

Background: Peak systolic longitudinal strain (PSLS) obtained using the 2D speckle tracking method is a novel indicator of the long‐axis function of the left ventricle (LV). We used the 2D strain profile to examine the effect of preload reduction by hemodialysis (HD) on LV PSLS in patients with end‐stage renal disease (ESRD). Method and results: Twenty‐nine pairs of echocardiographic evaluations were obtained before and after dialysis. Global LV PSLS was ?18.4 ± 2.9%, at baseline and decreased to ?16.9 ± 3.2% after HD (P < 0.001). Segmental analysis showed that the decrease in PSLS after dialysis was most prominent in mid‐LV segments (?17.1 ± 3.5% vs. ?15.4 ± 3.4%, P < 0.001). Conclusion: PSLS obtained from the 2D strain profile is a reliable parameter that may be useful for evaluating LV systolic long‐axis function. However, PSLS should be applied cautiously in ESRD patients because it could be affected by dialysis.