Skip to main content
SpringerLink
Log in

Left ventricular function in professional football players evaluated by tissue Doppler imaging and strain imaging

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Background

Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler Imaging(TDI) and Strain Myocardial Imaging(SI) are new tools in the evaluation systolic and diastolic myocardial function. We sought to compare TDI and SI findings in professional football players and age adjusted sedentary controls to assess the effect of regular athletic training on myocardial function.

Methods

Transthoracic echocardiography, M-mode, 2-D measurements, Doppler derived mitral-tricuspid annular velocities, reconstructed spectral pulsed wave tissue Doppler velocities, strain and strain rate imaging of seven different myocardial regions were obtained from 24 professional football players and age, sex and weight adjusted 20 controls.

Results

Age, body surface area, blood pressure and heart rate were comparable between 2 groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter and decreased transmitral diastolic late velocity.

In athletes TDI analysis showed significantly increased mitral annulus septal TDI peak early diastolic(e) velocity(0.22 ± 0.04 vs. 0.19 ± 0.04 m/s, P < 0.05), lateral TDI peak e velocity (0.19 ± 0.03 vs. 0.16 ± 0.02 m/s, P < 0.05) and lateral TDI e/a ratio (1.96 ± 0.41 and 1.66 ± 0.23, P < 0.05).

In SI analysis mid septal walls (1.71 ± 0.23 in athletes and 1.49 ± 0.25 in controls, P < 0.05) and mid lateral walls (1.55 ± 0.28 and 1.34 ± 0.25 respectively, P < 0.05) peak systolic strain rate values differences were found to be increased in athletes.

Conclusions

Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function which can be detected by TDI. Strain rate imaging may be a new tool to define subtle change in systolic left ventricular function in “athletes heart” which cannot be determined in standard echocardiographic parameters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Maron B (1986) Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol 7:190–203

    Article  PubMed  CAS  Google Scholar 

  2. Blomqvist CG, Saltın B (1983) Cardiovascular adaptations to physical training. Annu Rev Physiol 45:169–189

    Article  PubMed  CAS  Google Scholar 

  3. Ginzton LE, Conant R, Brizendine M et al (1989) Effect of longterm high intensity aerobic training on the left ventricular volume during maksimal upright exercise. J Am Coll Cardiol. 14:681–689

    Article  Google Scholar 

  4. Douglas PS, O’Toole ML, Hiller WD et al (1990) Different effects of prolonged exercise on the right and left ventricle. J Am Coll Cardiol 15:64–69

    Article  PubMed  CAS  Google Scholar 

  5. Fagard R (2003) Athlete’s heart Heart 89:1455–1461

    Article  PubMed  Google Scholar 

  6. Pellicia A, Cullaso F, Di Paolo FM et al (1999) Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 130:23–31

    Google Scholar 

  7. Fagard RH (1996) Athlete’s heart: a meta-analysis of the echocardiographic experience Int J Sport Med 17(suppl 3):S140–S144

    Article  Google Scholar 

  8. Fisher AG, Adams TD, Yanowitz FG et al (1989) Noninvasive evaluation of world class athletes engaged in different models of training. Am J Cardiol 63:337–341

    Article  PubMed  CAS  Google Scholar 

  9. Fagard RH (1997) Impact of different sports and training on cardiac structure and function. Cardiol Clin 15:397–412

    Article  PubMed  CAS  Google Scholar 

  10. Hoogsteen J, Hoogeveen A, Schaffers H et al (2004) Myocardial adaptation in different endurance sports: an echocardiographic study. Int J Cardiovasc Imaging 20:19–26

    Article  PubMed  CAS  Google Scholar 

  11. Pellicia A, Spataro A, Caselli G et al (1991) The upper limit of physiological hypertrophy in highly trained athletes. N Eng J Med 324:295–301

    Article  Google Scholar 

  12. Di Bello V, Cini G, Santaro G et al (1985) Echocardiographic evaluation of left ventricular mass and performance in football-players. J Sports Cardiol 2:32–37

    Google Scholar 

  13. Al-Hazzaa HM, Chukwuemeka AC (2001) Echocardiographic dimensions and maximal oxygen uptake in elite soccer players. Saudi Med J. Apr; 22(4):320–325 (Abstract)

    Google Scholar 

  14. Urhausen A, Monz T, Kinderman W (1996) Sports-specific adaptation of left ventricular muscle mass in athletes heart II: an echocardiographic study with 400-m runners and soccer players. Int J Sports Med 17:152–156

    Article  Google Scholar 

  15. Douglas F, Muir MB, Graham D et al (1999) The prevelance of left ventricular hypertophy in elite Professional footballers. Int J Cardiol 71:129–134

    Article  Google Scholar 

  16. Fishman EZ, Embon P, Pines A et al (1997) Comparison of left ventricular function using isometric exercise Doppler echocardiography in competitive runners and weightlifters versus sedentary individuals. Am J Cardiol 79:355–359

    Article  Google Scholar 

  17. Lewis JF, Spirito P, Pellicia A et al (1992) Usefulness of Doppler echocardiographic assessment of diastolic filling in distinguishing “athletes heart” from hypertrophic cardiomyopathy. Br Heart J 68:296–300

    Article  PubMed  CAS  Google Scholar 

  18. Nishimura RA, Abel MD, Hattle LK et al (1989) Assessment of diastolic function of the heart:background and current applications of Doppler echocardiography, II:clinical studies. Mayo Clin Proc 64:181–204

    PubMed  CAS  Google Scholar 

  19. Palka P, Lange A, Fleming AD et al (1995) Doppler tissue imaging: myocardial wall motion velocities in normal subjects. J Am Soc Echocardiogr 8:659–668

    Article  PubMed  CAS  Google Scholar 

  20. Donovan CL, Armstrong WF, Bach DS (1995) Quantitative Doppler tissue imaging of left ventricular myocardium: validation in normal subject. Am Heart J 130:100–104

    Article  PubMed  CAS  Google Scholar 

  21. Pellerin D, Sharma R, Eliot P et al (2003) Tissue Doppler, strain and strain rate echocardiography for the assessment of left and right systolic ventricular function. Heart 89(Supplement 3):9iii

    Article  Google Scholar 

  22. Caso P, D’Andrea A, Galderizi M et al (2000) Pulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and regional diastolic function. Am J Cardiol 85:1131–1136

    Article  PubMed  CAS  Google Scholar 

  23. Garcia-Fernandez MA, Bermejo J, Perez-David E et al (2003) New techniques for the assessment of regional left ventricular wall motion. Echocardiogr 20:659–672

    Article  Google Scholar 

  24. Jamal F, Kukulski T, Sutherland GR et al (2002) Can changes in systolic longitidunal deformation quantify regional myocardial function after an acute infarction? An ultrasonic strain rate and strain study J Am Soc Echocardiogr 15:1–12

    Article  PubMed  Google Scholar 

  25. Voigt JU, Exner B, Schmeidehausen K et al (2003) Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 107:2120–2126

    Article  PubMed  Google Scholar 

  26. Schiller NB, Shah PM, Crawford MH (1989) Recomendations for quantitation of the left ventricle by two dimensional echocardiography: American Society of Echocardiography committee on quantification of two dimensional echocardiogram. J Am Coll Cardiol 2:358–367

    CAS  Google Scholar 

  27. Sahn DJ, De Maria A, Kisslo J et al (1978) The Committee on Mmode Standardizations of the American Society of Echocardiography. Reccomendations regarding quantificatin in Mmode echocardiography:results of a survey of echocardiographic measurements. Circulation 58:1072–1083

    PubMed  CAS  Google Scholar 

  28. Devereaux’ RB (1987) Detection of left ventricular hypertrophy by M-mode echocardiography: anatomic validation, standardization and comparison to other methods. Hypertension 9(Suppl I):1280–1287

    Google Scholar 

  29. Tomiyoma H, Doba H, Kushioro T et al (1996) Prospective studies on left ventricular geometric patterns and exercise tolerance in unmedicated men with borderline and mild hypertension. J Hypertens 14:1223–1228

    Article  Google Scholar 

  30. Nagueh SF, Middleton KJ, Kopelen HA et al (1997) Doppler tissue imaging: a new non-invasive technique for evaluation of left ventricular relaxation and estimation of filling pressure. J Am Coll Cardiol 30:1527–1533

    Article  PubMed  CAS  Google Scholar 

  31. Bangsbo J (1994) The physiology of soccer. Acta Physiol Scand 151:1–155

    Article  Google Scholar 

  32. Reilly T (1994) Motion characteristic. In: Ekblom B (ed) Handbook of sport medicine and science. Football (Soccer). Blackwell, Oxford, 39p

    Google Scholar 

  33. Nagueh SF, Mıkatı I, Kopelen HA et al (1998) Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging. Circulation 16:1644–1650

    Google Scholar 

  34. Pluim BM, Zwinderman AH, Van Der Laarse A et al (2000) The athlete’s heart: a meta analysis of cardiac structure and function. Circulation 101:336–344

    PubMed  CAS  Google Scholar 

  35. Nottin S, Nguyen LD, Terbah M et al (2004) Left ventricular function in endurance-trained children by tissue Doppler imaging. Med Sci Sports Exerc 36:1507–1513

    Article  PubMed  Google Scholar 

  36. Fagard R, Van Der Broke C, Bielen E et al (1987) Assessment of stiffnes of hypertrophied left ventricle of bicyclist using left ventricular inflow Doppler velocimetry. J Am Coll Cardiol 9:1250–1254

    Article  PubMed  CAS  Google Scholar 

  37. Fagard R, Van Der Broke C, Amery A (1989) Left ventricle dynamics during exercise in elite marathon runners. 14:112–118

  38. Schmıdt-Trucksass A, Schmıd A, Haussler C et al (2001) Left ventricular wall motion during diastolic filling in endurance trained athletes. Med Sci Sports Exerc 33:189–195

    PubMed  Google Scholar 

  39. Baldi JC, McFarlane K, Oxenham HC et al (2003) Left ventricular diastolic filling and systolic function of young and older trained and untrained men. J Appl Physiol 95:2570–2575

    PubMed  Google Scholar 

  40. Kowalski M, Kukulski T, Jamal F et al (2001) Can natural strain and strain rate quantıfy regional myocardial deformation? A study in healty subjects. Ultrasound Med Biol 27:1087–1097

    Article  PubMed  CAS  Google Scholar 

  41. Edvardsen T, Aakhus S, Endersen K et al (2000) Acute regional myocardial ischemia identified by 2-dimensional multiregion tissue Doppler imaging technique. J Am Soc Echocardiogr 13:986–994

    Article  PubMed  CAS  Google Scholar 

  42. Mirsky J, Parmley WW (1973) Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res 33:233–244

    PubMed  CAS  Google Scholar 

  43. Abraham TP, Nishimura RA (2001) Myocardial strain: can we finally measure contractility? J Am Coll Cardiol 37:731–734

    Article  PubMed  CAS  Google Scholar 

  44. Weber KT, Janıckı JS (1977) Instantaneous force-velocity-length relations in isolated dog heart. Am J Physiol 232:H241–H249

    PubMed  CAS  Google Scholar 

  45. Heimdal A, Stoylen A, Torp H et al (1998) Real-time strain rate imaging of the left by ultrasound. J Am Soc Echocardiogr 11:1013–1019

    Article  PubMed  CAS  Google Scholar 

  46. Weidemann F, Eyskens B, Jamal F et al (2002) Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound-based strain rate and strain imaging. J Am Soc Echocardiogr 15:20–28

    Article  PubMed  Google Scholar 

  47. Urheim S, Edvardsen T, Torp H et al (2000) Myocardial strain by Doppler echocardiography: validation of a new method to quantify regional myocardial function. Circulation 102:1158–1164

    PubMed  CAS  Google Scholar 

  48. Weidemann F, Mertens L, Gewillig M et al (2001) Quantitation of localized abnormal deformation in asymmetric nonobstructive hypertrophic cardiomyopathy: a velocity, strain rate, and strain Doppler myocardial imaging study. Pediatr Cardiol 22:534–537

    Article  PubMed  CAS  Google Scholar 

  49. Kukulski T, Jamal F, D’Hooge J et al (2002) Acute changes in systolic and diastolic events during clinical coronary angioplasty: a comparison of regional velocity, strain rate, and strain measurement. J Am Soc Echocardiogr 15:1–12

    Article  PubMed  Google Scholar 

  50. Greenberg NL, Firstenberg MS, Castro PL et al (2002) Dopplerderived myocardial systolic strain rate is a strong index of left ventricular contractility. Circulation 105:99–105

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, University of Gaziosmanpasa, Tokat, Turkey

    Mustafa Murat Tümüklü

  2. Department of Biostatistics, Faculty of Medicine, University of Gaziosmanpasa, Tokat, Turkey

    Ilker Etikan

  3. Department of Cardiology, Faculty of Medicine, University of Ege, Izmir, Turkey

    Cahide Soydaş Çinar

Authors
  1. Mustafa Murat Tümüklü
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ilker Etikan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cahide Soydaş Çinar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mustafa Murat Tümüklü.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tümüklü, M.M., Etikan, I. & Çinar, C.S. Left ventricular function in professional football players evaluated by tissue Doppler imaging and strain imaging. Int J Cardiovasc Imaging 24, 25–35 (2008). https://doi.org/10.1007/s10554-007-9218-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-007-9218-8

Keywords

Search

Navigation