Strain Imaging: Key to the Specific Left Ventricular Diastolic Properties in Endurance Trained Athletes

Journal of Clinical and Basic Cardiology 2003; 6 (1-4): 35-40

PDF    Summary    Figures   




Keywords: Athlet,  Ausdauer,  diastole,  ischämische Herzkrankheit,  Kardiologie,  linker Ventrikel,  Training,  athlete,  cardiology,  diastole,  Endurance,  ischaemic heart disease,  left ventricle,  Training

Background: To increase the performance capacity of endurance trained athletes (ETA), a variety of adaptations are imperative. The heart is the central and the most important limiting factor. The structural heart adaptations in ETA have important repercussions on cardiac function. The left ventricular diastole shows specific characteristics that determine the performance capacity. Methods: 40 male ETA were compared with 31 active male controls and with 112 coronary patients. All subjects underwent tissue Doppler and strain imaging in equal basal conditions. Results: Compared with normal controls we noted similar signs of both eccentric and concentric left ventricular hypertrophy in ETA as well as in patients with severe ischaemic heart disease. In contrast with the disturbed diastolic function in the coronary patients, the left ventricular diastolic function in the ETA was perfectly normal and even different and better than in the healthy control group. Excluding influences of preload, the values of the pulsed Doppler tissue imaging peak atrial systolic velocities (A), peak early diastolic velocities (E) and E/A ratios clearly indicate that the ETA have a supernormal left ventricular function compared with the nonathletic men. Extremely striking were the significant differences between the three groups concerning the strain values at the basal and the mid septum in the longitudinal axis by aortic valve closure and by mitral valve opening. Fascinating were the values of the enddiastolic strain at the end of the A-wave: negative in ETA, near zero in normal controls and markedly positive in patients with severe ischaemic heart disease. Conclusions: In spite of signs of combined eccentric and concentric left ventricular hypertrophy, the left ventricular systolic and diastolic functions remain normal and even supernormal in ETA. Arguments in support of this thesis were found by two dimensional echocardiographic Doppler examinations, by pulsed Doppler tissue imaging and by strain imaging. Interpreting our results obtained by strain imaging, we try to explain the specific left ventricular diastolic properties in ETA.