Francesco Lo Iudice1, Marta Petitto1, Marco Ferrone1, Roberta Esposito2, Andrea Vaccaro3, Agostino Buonauro2, Antonello D'Andrea4, Bruno Trimarco1, Maurizio Galderisi1. 1. Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5, bld 1, 80131 Naples, Italy. 2. Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy. 3. Department of Medicine and Surgery, Federico II University Hospital, Naples, Italy. 4. Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
Abstract
AIMS: The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes. METHODS AND RESULTS: A total of 36 top-level male endurance athletes (AT) and 36 age-matched sedentary normal controls (NC) underwent standard and real-time 3D echocardiography. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were assessed using 3D STE. AT had significantly higher GLS (-22.1 ± 4.4 vs. -18.4 ± 3.5%; P < 0.0001), GCS (-17.9 ± 2.4 vs. -16.0 ± 3.2; P = 0.006), and GAS (-35.5 ± 6.7 vs. -30.2 ± 4.9; P < 0.0001), while GRS did not differ significantly with NC. At separate multiple linear regression analyses, heart rate emerged as independent predictor of GLS (β = -0.37, P < 0.002), GCS (β = -0.32, P = 0.007), GAS (β = -0.37, P < 0.001), and GRS (β = -0.29, P = 0.019); LV mass was independently associated with GLS (β = 0.34, P = 0.009) and GAS (β = 0.41, P < 0.001) but not with GCS and GRS, while diastolic blood pressure predicted GCS (β = -0.46, P < 0.0001), GAS (β = -0.28; P = 0.006), and GRS (β = -0.42, P < 0.001). No independent correlation emerged for body surface area and stroke volume. By replacing LV mass with end-diastolic volume, the latter showed independent association with GCS (β = -0.65, P = 0.028) and with GRS (β = -0.60, P < 0.05). CONCLUSION: AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres. Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal myocardial deformation at rest. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes. METHODS AND RESULTS: A total of 36 top-level male endurance athletes (AT) and 36 age-matched sedentary normal controls (NC) underwent standard and real-time 3D echocardiography. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were assessed using 3D STE. AT had significantly higher GLS (-22.1 ± 4.4 vs. -18.4 ± 3.5%; P < 0.0001), GCS (-17.9 ± 2.4 vs. -16.0 ± 3.2; P = 0.006), and GAS (-35.5 ± 6.7 vs. -30.2 ± 4.9; P < 0.0001), while GRS did not differ significantly with NC. At separate multiple linear regression analyses, heart rate emerged as independent predictor of GLS (β = -0.37, P < 0.002), GCS (β = -0.32, P = 0.007), GAS (β = -0.37, P < 0.001), and GRS (β = -0.29, P = 0.019); LV mass was independently associated with GLS (β = 0.34, P = 0.009) and GAS (β = 0.41, P < 0.001) but not with GCS and GRS, while diastolic blood pressure predicted GCS (β = -0.46, P < 0.0001), GAS (β = -0.28; P = 0.006), and GRS (β = -0.42, P < 0.001). No independent correlation emerged for body surface area and stroke volume. By replacing LV mass with end-diastolic volume, the latter showed independent association with GCS (β = -0.65, P = 0.028) and with GRS (β = -0.60, P < 0.05). CONCLUSION: AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres. Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal myocardial deformation at rest. Published on behalf of the European Society of Cardiology. All rights reserved.
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