title: Echocardiographic deformation imaging reveals preserved regional systolic function in endurance athletes with left ventricular hypertrophy.
abstract: BACKGROUND
  Left ventricular hypertrophy (LVH) is often observed in athletes, which should be differentiated from hypertrophic cardiomyopathy. The aim of the study was to explore the functional changes measured using tissue Doppler imaging (TDI) deformation analysis in athletes fulfilling LVH criteria participating in different endurance sports.
  
  
  METHODS
  Healthy controls (n = 62, 58% men) and endurance athletes (n = 120, 62% men) aged 18-40 years were prospectively enrolled and underwent both standard echocardiography as well as TDI. Longitudinal TDI-derived strain and strain rate (SR) were calculated in the septal and posterior wall in three segments. LVH was defined as a left ventricular mass (LVM) over 132 g/m2 in men and over 109 g/m2 in women.
  
  
  RESULTS
  Echocardiographic LVH was observed in 33 athletes (67% men). LVM was significantly increased in both athlete groups (102.6 g/m2 (SD 16.0) and 135.7 g/m2 (SD 15.9) vs 88.0 g/m2 (SD 16.5) in controls, p<0.001). Diastolic parameters were not significantly different between groups. Athletes with LVH showed no significant difference in strain and SR values in any segment of the septal or posterior wall compared with controls or those without LVH. A weak but significant correlation (also after multivariate analysis) was found for septal wall thickness and LVM in peak systolic strain (r = 0.26, p<0.01 and 0.23, p<0.01) and SR (r = 0.27, p<0.01 and 0.29, p<0.01). Nevertheless, strain and SR values were still within normal limits in all athletes.
  
  
  CONCLUSIONS
  Athletes with LVH overall show normal deformation values in the left ventricle. These data suggest that a moderate reduction in regional septal deformation should not be considered as pathological when evaluating the endurance athlete with echocardiographic LVH of unknown origin.
authors.affiliation: University Medical Center Utrecht, Department of Cardiology, HP F.02.352, Heidelberglaan100, 3582 CX Utrecht, The Netherlands. a.j.teske@gmail.com
authors.forename: A J
authors.initials: AJ
authors.lastname: Teske
authors.forename: N H
authors.initials: NH
authors.lastname: Prakken
authors.forename: B W
authors.initials: BW
authors.lastname: De Boeck
authors.forename: B K
authors.initials: BK
authors.lastname: Velthuis
authors.forename: P A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: M J
authors.initials: MJ
authors.lastname: Cramer
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D010807:Physical Endurance / Q000502:physiology; D013177:Sports / Q000502:physiology*; D013599:Systole; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology; D055815:Young Adult