Assessment of the Left Ventricular Chamber Stiffness in Athletes

Abstract

Since diastolic dysfunction is an early sign of the heart disease, detecting diastolic disturbances is predicted to be the way for early recognizing underlying heart disease in athletes. So-called chamber stiffness index (E/e')/LVDd was predicted to be useful in distinguishing physiological from pathological left ventricular hypertrophy, because it was shown to be reduced in athletes. It remains unknown whether it is reduced in all athletic population. Standard and tissue Doppler were used to assess cardiac parameters at rest in 16 elite male wrestlers, 21 water polo player, and 20 sedentary subjects of similar age. In addition to (E/e')/LVDd index, a novel (E/e')/LVV, (E/e')/RVe'lat indices were determined. Progressive continuous maximal test on treadmill was used to assess the functional capacity. VO(2) max was the highest in water polo players, and higher in wrestlers than in controls. LVDd, LVV, LVM/BH(2.7) were higher in athletes. Left ventricular early diastolic filling velocity, deceleration and isovolumetric relaxation time did not differ. End-systolic wall stress was significantly higher in water polo players. RV e' was lower in water polo athletes. Right atrial pressure (RVE/e') was the highest in water polo athletes. (E/e'lat)/LVDd was not reduced in athletes comparing to controls (water polo players 0.83 ± 0.39, wrestlers 0.73 ± 0.29, controls 0.70 ± 0.28; P = 0.52), but (E/e's)/RVe'lat better distinguished examined groups (water polo players 0.48 ± 0.37, wrestlers 0.28 ± 0.15, controls 0.25 ± 0.16, P = 0.015) and it was the only index which predicted VO(2) max. In conclusion, intensive training does not necessarily reduce (E/e'lat)/LVDd index. A novel index (E/e's)/RVe'lat should be investigated furthermore in detecting diastolic adaptive changes.

Cardiac function and long-term volume load : Physiological investigations in endurance athletes and in patients operated on for aortic regurgitation

“…120 This inconsistency in previous results could probably in part be explained by the diversity in sports performed by included endurance athletes.…”

The role of echocardiography in the evaluation of cardiac re-modelling and differentiation between physiological and pathological hypertrophy in teenagers engaged in competitive amateur sports

“…We suggest that examination with tissue Doppler and other modern imaging techniques such as strain rate test and MRI should be performed once there is proven left ventricular mass hypertrophy exceeding the physiological limits, whereas assessment of diastolic dysfunction with Tissue Doppler can be crucial for the diagnosis of hypertrophy. [26][27][28]…”

When does the E/e’ index not work? The pitfalls of oversimplifying diastolic function

“…The E/e’ index at rest is unaltered in subjects who exercise regularly. It was similar in male athletes undertaking predominantly dynamic exercise (water polo) or combined dynamic and isometric exercise (wrestling) to that observed in sedentary controls, 25 and it was unchanged in female athletes after 16 weeks of intensive training 26 . In healthy subjects, the E/e’ also does not change on exercise.…”