title: The feasibility and usefulness of contrast exercise echocardiography for the assessment of left ventricular function in master athletes.
abstract: BACKGROUND
  The number of competitive master athletes (MA, over 40 years) has been rising. Since the incidence of coronary artery disease (CAD) is increasing in this population, cardiovascular pre-participation screening, including a maximum exercise test, is recommended. In this context the addition of contrast to echo could be useful because wall thickening and motion are better markers of myocardial function when the whole endocardial border (EB) is visible.
  
  
  OBJECTIVE
  To evaluate the feasibility and usefulness of rest and exercise contrast echo for the assessment of LV wall motion in competitive master athletes with suboptimal acoustic windows.
  
  
  METHODS
  Forty consecutive MA underwent echo and contrast echo both at rest and during exercise. Contrast-enhanced images were achieved at rest and at peak exercise after administration of SonoVue (BR1), using apical 4 and 2-chamber views divided into 6 myocardial segments (MS). The EB resolution for each segment was graded as: 0=not visible, 1=barely visible, 2=well-delineated.
  
  
  RESULTS
  In the baseline at-rest echo 17/40 (45%) patients were graded as score 0, 22/40 (55%) were graded as score 1 and only 1 athlete has reached score 2. In at-rest echo contrast 28/40 (70%) athletes have reached score 1 and 12/40 (30%) score 2. Nobody was graded as score 0. At the same time in the baseline peak-exercise echo 12/40 (30%) athletes were graded as score 0, 24/40 (60%) athletes reached score 1 and 4/40 (10%) score 2, while using contrast at peak-exercise echo 28/40 (70%) were grated as score 1 and 12/40 (30%) reached score 2. The differences about the grading of the score between the two groups with and without contrasts, at rest and at peak exercise, are statistically significant (p<0.001). Considering the whole of the MS analyzed in the majority of the athletic population studied, we can see that at-rest echo, 64/480 MS (13.3%) were graded as 0, 156/480 MS (32.5%) as 1 and 260/480 MS (54.2%) were graded 2, while in the peak-exercise 96/480 MS (20%) were graded as 0, 235/480 MS (48.9%) as 1 and 209/480 MS (43.5%) were graded 2. On the other hand, using contrast, in at-rest echo, 480/480 MS (100%) were graded as 2 while in the peak-exercise echo 460/480 MS (95.9%) were graded as 2 and 20/480 MS (4.1%) as 1. The percentage of the MS graded as 2 reach almost the whole number of the analyzed MS with a percentage increment in the at-rest and peak-exercise echo of 85% and 120%, respectively.
  
  
  CONCLUSIONS
  Our results show that the use of contrast echo improves the visibility of the EB in a way that the two groups of competitive athletes show at rest and after exercise a significant increment of the score 2 compatible with a better visibility of the EB. These results suggest that contrast echo, both at rest and during exercise, is a better method for EB analysis to understand the behaviour of the wall motion in subjects with suboptimal acoustic windows, and could be suitable for cardiovascular screening in master athletes.
authors.affiliation: Department of Medical and Surgical Critical Care, Laboratory of Non-Invasive Cardiology, Sports Medicine Centre, University of Florence, Viale Gian Battista Morgagni, 85, 50134, Florence, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Rizzo
authors.forename: Maria Concetta Robertina
authors.initials: MC
authors.lastname: Vono
authors.forename: Loira
authors.initials: L
authors.lastname: Toncelli
authors.forename: Patricia
authors.initials: P
authors.lastname: Peçagna
authors.forename: Paolo
authors.initials: P
authors.lastname: Manetti
authors.forename: Laura
authors.initials: L
authors.lastname: Stefani
authors.forename: Giorgio
authors.initials: G
authors.lastname: Galanti
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods*; D004699:Endocardium / Q000000981:diagnostic imaging; D005080:Exercise Test; D005240:Feasibility Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D013177:Sports; D013459:Sulfur Hexafluoride; D016277:Ventricular Function, Left
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride