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Three-Dimensional Echocardiographic Characterization of Left Ventricular Remodeling in Olympic Athletes

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The aim of the present study was to assess, using 3-dimensioanl echocardiography, the morphologic characteristics, determinants, and physiologic limits of left ventricular (LV) remodeling in 511 Olympic athletes (categorized in skill, power, mixed, and endurance sport disciplines) and 159 sedentary controls matched for age and gender. All subjects underwent 3-dimensional echocardiography for the assessment of LV volumes, ejection fraction, mass, remodeling index (LV mass/LV end-diastolic volume), and systolic dyssynchrony index (obtained by the dispersion of the time to minimum systolic volume in 16 segments). Athletes had higher LV end-diastolic volumes (157 ± 35 vs 111 ± 26 ml, p <0.001) and mass (156 ± 38 vs 111 ± 25 g, p <0.001) compared to controls. Body surface area and age had significant associations with LV end-diastolic volume (R2 = 0.49, p <0.001) and mass (R2 = 0.51, p <0.001). Covariance analysis showed that also gender and type of sport were significant determinants of LV remodeling; in particular, the highest impact on LV end-diastolic volume and mass was associated with male gender and endurance disciplines (p <0.001). Regardless of the type of sport, athletes had similar LV remodeling indexes to controls (1.00 ± 0.06 vs 1.01 ± 0.07 g/mL, p = 0.410). No differences were found between athletes and controls for the ejection fraction (62 ± 5% and 62 ± 5%, p = 0.746) and systolic dyssynchrony index (1.06 ± 0.40% and 1.37 ± 0.41%, p = 0.058). In conclusion, 3-dimensional echocardiographic morphologic and functional assessment of the left ventricle in Olympic athletes demonstrated a balanced adaptation of LV volume and mass, with preserved systolic function, regardless of specific disciplines participated.

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Methods

From January to July 2008 and from April to June 2009, we evaluated 515 consecutive Olympic athletes, members of the Italian national team, selected for participation in the 2008 Beijing Olympic Games and the 2009 Pescara Pan-Mediterranean Games. All athletes were evaluated at the Institute of Sports Medicine and Science during period of intensive training.

According to our protocol, each athlete underwent physical examination, rest and exercise 12-lead electrocardiography, and 2-dimensional and

Results

Demographic characteristics of athletes and untrained controls are listed in Table 1. The distribution of LV end-diastolic volume and mass among male and female athletes is displayed Figure 1, Figure 2. The means and ranges of values in healthy volunteers and athletes according to sport disciplines are listed in Table 2 for men and Table 3 for women.

Athletes had higher LV end-diastolic volumes (157 ± 35 vs 111 ± 26 ml, p <0.001) compared to controls. Subgroup analysis, according to the sport

Discussion

Our study provides original data on LV remodeling patterns and functional characteristics, derived from 3DE, in a unique and wide population composed of elite Olympic athletes engaged in different sport disciplines. We sought to assess the morphologic cardiac characteristics using this technique, which is capable of accurately quantify LV volumes and mass in a fashion similar to cardiac magnetic resonance9, 12, 13, 15, 23; indeed, 3DE proved to be reproducible, relatively low cost, and

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