Original Articles
Assessment of regional systolic and diastolic wall motion velocities in highly trained athletes by pulsed wave Doppler tissue imaging*

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Abstract

We studied the relationship between left ventricular (LV) function and the increased LV mass in 18 highly trained rowing athletes (14 men, 4 women; mean age 20.7 ± 4.5 years) using pulsed wave Doppler tissue imaging (PWDTI). Thirteen untrained volunteers, matched for age and body mass index, acted as control participants. Peak systolic, early diastolic (Ev), and late diastolic (Av) myocardial velocities (cm/s); Ev/Av ratio; and isovolumic relaxation time (ms) were measured at the level of basal lateral wall and basal posterior interventricular septum (bas-IVS) segments. In comparison with control participants, athletes showed a greater LV cavity size (P <.05), wall thickness (IVS, P <.001; posterior wall, P <.01), and mass index (P <.001). In athletes, systolic velocity of bas-IVS had increased (P <.001) and was positively correlated with IVS thickness (r = 0.66, P <.005) and LV mass index (r = 0.71, P <.001). Of the PWDTI-measured diastolic indexes, Ev/Av ratio significantly increased in athletes in comparison with control participants in both the examined segments (bas-IVS, P <.05; basal lateral wall, P <.05). When Ev and Av were separately considered, a different behavior was found in the 2 segments: Ev significantly increased in the basal lateral wall (P <.005); Av significantly decreased in the bas-IVS. The increase in the systolic velocity of bas-IVS suggests that septum greatly contributes to the longitudinal LV systolic shortening and increase of stroke volume in athletes compared with untrained participants. Moreover, the behavior of PWDTI diastolic velocities suggests a more effective relaxation activity in the longitudinal axis at the level of lateral wall. This study suggests therefore the usefulness of PWDTI in the assessment of functional properties of “athlete's heart” and differentiation from pathologic cardiac conditions. (J Am Soc Echocardiogr 2002;15:900-5.)

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Study population

Eighteen competitive athletes, 10 rowers and 8 canoeists, (14 men and 4 women, mean age 21 ± 4 years, range 15-28 years) represented our study group. These athletes agreed to participate in the study under a written invitation forwarded to an athletic association of our city, Cagliari, Italy. They had been training and competing for an average of 3 years (range 1-11 years) and, at the time of this investigation, were engaged in their training for 1 hour per day or more, for 5 days per week or

LV morphology and function

Table 2 shows the most significant morphologic and functional echocardiographic findings in our study population.LV cavity dimensions and wall thickness were increased in athletes in comparison with control participants. LVMI increased in athletes compared with control participants and exceeded upper normal limits (134 g/m2)7 in 7 men; no woman exceeded the upper normal limit for women (110 g/m2).7 Systolic LV function, as expressed by ejection fraction, was at normal levels in both athletes

Athlete's heart and conventional echocardiography

Several studies demonstrate that physical training is associated with an increase in LV cavity size, wall thickness, and mass,1 which is considered a physiologic LV adaptation aimed to normalize the increased parietal stress.11 Echocardiographic studies have supported the concept that LVH in highly trained athletes has no pathologic implication4, 5, 12 because global systolic function and diastolic filling patterns were found to be within normal limits in these participants.2, 13, 14, 15 In

Acknowledgements

The authors acknowledge the expert editorial assistance of Enrico Lampis.

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    *

    Reprint requests: Sandra Zoncu, MD, Department of Cardiovascular Sciences, University of Cagliari, Policlinico Universitario, S. S. 554-Bivio Sestu, 03042 Monserrato (Cagliari), Sardinia, Italy (E-mail: [email protected]).

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