Left ventricular remodeling and the athlete's heart, irrespective of quality load training.

BACKGROUND: Regular physical exercise determines a progressive increase of the cardiac mass known as adaptive hypertrophy. Up to now, two morphological echocardiographic heart patterns of athletes have been described by Morganroth in 1975: predominant augmentation of wall thickness, and major cavity size in chamber dimensions in the case of prevalent static or dynamic components. The aim of the study was to follow up the impact of physical training on heart morphology and function in a group of elite soccer and rugby players for at least five years. METHOD: From January 1993 to December 2015 a group of 250 elite soccer players and 114 rugby players were examined: 78 soccer players and 60 rugby players were followed up for 5 years. They were matched with a control group. RESULTS: LV dimensions and LVMi were significantly higher in the athletes than in the inactive subjects (LVMi : 123.45; LVMi: 81.5 vs 94.36 g/m2 respectively). After the five-year follow up the athletes showed no significant modifications in cardiac dimensions: (LVDd from 52.00 ± mm to 52.90 ± mm; LVSd increased from 31.58 ± mm to 32.33 ± mm; Left Ventricular CMI from 120.77 to 121.45 g/m2;p = NS in soccer; from 50.43 ± mm to 52.22 ± mm; Left Ventricular Systolic diameter increased from 32.51 ± mm to 32.8 ± mm; Left Ventricular Mass index from 81,5 to 87,4 g/m2;p = NS and no significant enhancement of the aortic root diameter was observed (Aortic root: from 27.39 mm to 31.64 mm in soccer players; from 30,68 mm to 30.95 mm). CONCLUSIONS: No significant differences were found among the athletes practicing sports with different workload components, and resistance training. In trained athletes the dimensions of the LV chamber and LVMi are generally within the upper limits of the normal range. After a five-year follow-up, the dimensions of the chambers of the heart remain within the normal range, despite being within the the upper limits. Regular physical exercise induces mild LV hypertrophy which therefore can be considered an adaptive consequence to stress-exercise.

Dragon Boat training exerts a positive effect on myocardial function in breast cancer survivors.

INTRODUCTION: Dragon Boat training is often suggested to control upper limb edema in breast cancer (BC) survivors, but little information is available regarding the cardiac impact of such activity. The present study evaluates this aspect during a 4-year follow-up of BC survivors. MATERIAL AND METHODS: From 2006 to 2010, 55 women diagnosed with BC in 2005, treated with adjuvant therapy without evidence of metastases, were enrolled for competitive Dragon Boat training. They underwent ergometric tests yearly, and 2D echocardiography to evaluate hemodynamic, morphological and functional cardiac parameters. RESULTS: The data were compared with those from a group of 36 healthy women (HW). Both groups maintained normal systolic function throughout the period, with Cardiac Mass index, Body Mass Index and Ejection Fraction values being higher in HW. At the onset of the study, the diastolic function of BC survivors was normal though compatible with initial diastolic dysfunction when compared to the diastolic function of HW. After 4 years of competitive activity, the diastolic parameters improved in both groups and particularly in BC survivors (A peak: from 68.5 ± 15.1 cm/s to 50 ± 14.1 cm/s, p < 0.05; Ea: from 9.3 ± 2 cm/s to 11.89 ± 1.7 cm/s, p < 0.001). CONCLUSIONS: BC survivors experienced a significant improvement in diastolic function after 4 years of Dragon Boat training. Dragon Boat training impacts favorably on the myocardial performance in patients previously treated with chemotherapy. These results support the positive role of sport activity in myocardial function of BC survivors.

Supernormal functional reserve of apical segments in elite soccer players: an ultrasound speckle tracking handgrip stress study.

BACKGROUND: Ultrasound speckle tracking from grey scale images allows the assessment of regional strain derived from 2D regardless of angle intonation, and it is highly reproducible. The study aimed to evaluate regional left ventricular functional reserve in elite soccer players. METHODS: 50 subjects (25 elite athletes and 25 sedentary controls), aged 26 +/- 3.5, were submitted to an echo exam, at rest and after the Hand Grip (HG) test. Both standard echo parameters and strain were evaluated. RESULTS: Ejection fraction was similar in athletes and controls both at rest (athletes 58 +/- 2 vs controls 57 +/- 4 p ns) and after HG (athletes 60 +/- 2 vs controls 58 +/- 3 p ns). Basal (septal and anterior) segments showed similar strain values in athletes and controls both at rest (athletes S% -19.9 +/- 4.2; controls S% -18.8 +/- 4.9 p = ns) and after HG (athletes S% -20.99 +/- 2.8; controls S% -19.46 +/- 4.4 p = ns). Medium-apical segments showed similar strain values at rest (athletes S% -17.31 +/- 2.3; controls S% -20.00 +/- 5.3 p = ns), but higher values in athletes after HG (athletes S% -24.47 +/- 2.8; controls S% -20.47 +/- 5.4 p < 0.05) CONCLUSION: In athletes with physiological myocardial hypertrophy, a brief isometric effort produces enhancement of the strain in medium-apical left ventricular segments, suggesting the presence of a higher regional function reserve which can be elicited with an inotropic challenge and suitable methods of radial function quantification such as 2D-derived strain.

Two-dimensional tracking and TDI are consistent methods for evaluating myocardial longitudinal peak strain in left and right ventricle basal segments in athletes.

BACKGROUND: Myocardial contractility can be investigated using longitudinal peak strain. It can be calculated using the Doppler-derived TDI method and the non-Doppler method based on tissue tracking on B-mode images. Both are validated and show good reproducibility, but no comparative analysis of their results has yet been conducted. This study analyzes the results obtained from the basal segments of the ventricular chambers in a group of athletes. METHODS: 30 regularly-trained athletes were submitted to an echocardiography at rest and after handgrip. Starting from the four-chamber view, overall myocardial function and regional velocities were evaluated. The images obtained were processed to determine strain in left and right ventricle basal segments. Strain was calculated using the TDI method and a validated "speckle tracking" or, more correctly, "feature tracking" algorithm. The statistical analysis included a Student's t-test (p < 0.05). RESULTS: The range of strain values obtained is in agreement with the data reported in the literature. In the left ventricle (LV) the average strain values of the basal segments calculated with TDI on IVS and LW at rest and after stress were: -21.05 +/- 3.31; -20.41 +/- 2.99 and -20.05 +/- 2.61; -21.20 +/- 2.37, respectively. In the right ventricle (RV) the same method gave IVS and LW strain values at rest of -22.22 +/- 2.58 ; -24.42 +/- 5.84, and after HG of -22.02 +/- 5.20 ;-23.93 +/- 6.34. The values obtained using feature tracking were: LV at rest -20.48 +/- 2.65 for IVS, and -21.25 +/- 2.85 for LW; LV after HG: -19.48 +/- 3 for IVS and -21.69 +/- 3.85 for LW. In RV at rest: -21.46 +/- 3.25 for IVS and -24.13 +/- 5.86 for LW; RV after HG: -24.79 +/- 7.9 for IVS and -24.13 +/- 7.0 for LW. Tissue Doppler and "feature tracking" methods showed the respective consistency of the results in the basal segments of myocardial ventricle walls. CONCLUSION: Provided that echographic imaging is good, strain can be computed in athletes by both Doppler-derived and tracking methods. It is technically feasible to use both -interchangeably, at least in basal segments.