title: Left ventricular untwisting in athlete's heart: key role in early diastolic filling?
abstract: Untwisting contributes to left ventricular filling through suction generation. We sought to investigate diastolic function and untwisting dynamics in different forms of left ventricular hypertrophy: in athlete's heart and hypertrophic cardiomyopathy. Elite athletes in kayaking, canoeing and rowing (n=28), patients with hypertrophic cardiomyopathy (HCM, n=15) and healthy sedentary volunteers (n=13) were compared. Left ventricular volumes, wall thickness-to-volume ratio were assessed by cardiac MRI. Following conventional and tissue Doppler measurements, untwist and untwist rate were determined by speckle tracking echocardiography. Wall thickness-to-volume ratio describing remodelling was significantly higher in HCM, but similar in athletes and controls (athlete vs. HCM vs. control: 0.107±0.019 vs. 0.271±0.091 vs. 0.104±0.012 mm×m²/ml, mean±SD, p<0.001). Mitral lateral annulus e' velocity referred to diastolic dysfunction in HCM (15.3±3.6 vs. 7.9±3.3 vs. 15.0±3.0 cm/s, p<0.01). At time point of mitral valve opening, untwist and untwist rate were significantly different: the highest values were measured in athletes, while the lowest were found in HCM (untwist: 51.3±19.1 vs. 11.6±10.4 vs. 35.9±16.3%; untwist rate: -32.5±13.0 vs. -10.6±10.8 vs. -23.0±7.7°/s, p<0.05). Untwisting correlated with E/A, e' and E/e'. Athlete's heart is characterized by increased untwist and untwist rate, which can aid diastolic function. Evaluation of untwisting dynamics may help to distinguish pathological hypertrophy.
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Kovács
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Apor
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Nagy
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: H
authors.initials: H
authors.lastname: Vágó
authors.affiliation: Heart and Vascular Center, Diagnostic Radiology Unit, Semmelweis University, Budapest, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Tóth
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: A I
authors.initials: AI
authors.lastname: Nagy
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: T
authors.initials: T
authors.lastname: Kováts
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: B
authors.initials: B
authors.lastname: Sax
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Széplaki
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: D
authors.initials: D
authors.lastname: Becker
authors.affiliation: Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary.
authors.forename: B
authors.initials: B
authors.lastname: Merkely
mesh_terms: D003971:Diastole; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D064797:Physical Conditioning, Human; D013177:Sports / Q000502:physiology*; D014463:Ultrasonography; D016276:Ventricular Function