title: 3D Strain helps relating LV function to LV and structure in athletes.
abstract: BACKGROUND
  The evaluation of cardiac contraction could benefit from a connection with the underlying helical structure of cardiac fibers in athletes either completely healthy or with minor common cardiopathies like Bicuspid Aortic Valve (BAV). This study aims to exploit the potential role of 3D strain to improve the physiological understanding of LV function and modification due to physical activity as a comparative model.
  
  
  METHODS
  Three age-matched groups of young (age 20.3 ± 5.4) individuals are prospectively enrolled: 15 normal healthy subjects, 15 healthy athletes, and 20 athletes with bicuspid aortic valve (BAV). All subjects underwent echocardiographic examination and both 2D and 3D strain analysis.
  
  
  RESULTS
  All echo parameters were within the normal range in the three groups. Global values of end-systolic longitudinal and circumferential strain, assesses by either 2D or 3D analysis, were not significantly different. The 3D strain analysis was extended in terms of principal and secondary strain (PS, SS). Global PS was very similar, global SS was significantly higher in athletes and displays a modified time course. The comparative analysis of strain-lines pattern suggests that the enhancement of LV function is achieved by a more synchronous recruitment of both left- and right-handed helical fibers.
  
  
  CONCLUSIONS
  3D strain analysis allows a deeper physiological understanding of LV contraction in different types of athletes. Secondary strain, only available in 3D, identifies increase of performances due to physical activity; this appears to follow from the synergic activation of endocardial and epicardial fibers.
authors.affiliation: Sport Medicine Center, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. laura.stefani@unifi.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Stefani
authors.forename: Alessio
authors.initials: A
authors.lastname: De Luca
authors.forename: Loira
authors.initials: L
authors.lastname: Toncelli
authors.forename: Gianni
authors.initials: G
authors.lastname: Pedrizzetti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Galanti
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D000082882:Bicuspid Aortic Valve Disease; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013177:Sports; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left
references.citation: Hypertension. 1987 Feb;9(2 Pt 2):II19-26
references.pmid: 2948914
references.citation: Cardiovasc Ultrasound. 2011 Oct 12;9:27
references.pmid: 21992622
references.citation: Int J Cardiovasc Imaging. 2011 Jan;27(1):91-100
references.pmid: 20623194
references.citation: Circ Cardiovasc Imaging. 2012 Nov;5(6):808-9
references.pmid: 23169983
references.citation: J Am Soc Echocardiogr. 2011 Mar;24(3):277-313
references.pmid: 21338865
references.citation: Phys Rev Lett. 2012 Jul 27;109(4):048103
references.pmid: 23006111
references.citation: Med Sci Sports Exerc. 2009 Jan;41(1):26-34
references.pmid: 19092706
references.citation: Clin Sci (Lond). 2011 Feb;120(4):143-52
references.pmid: 20815809
references.citation: Am J Cardiol. 2010 Jul 15;106(2):278-83
references.pmid: 20599016
references.citation: Curr Cardiol Rep. 2003 Mar;5(2):110-5
references.pmid: 12583853
references.citation: J Am Coll Cardiol. 2005 Apr 19;45(8):1364-7
references.pmid: 15837288
references.citation: Med Sci Sports Exerc. 2010 Jun;42(6):1215-20
references.pmid: 19997021
references.citation: Int J Cardiovasc Imaging. 2011 Jan;27(1):105-11
references.pmid: 20652749
references.citation: J Am Soc Echocardiogr. 2014 Oct;27(10):1041-1050.e1
references.pmid: 24998517
references.citation: Radiology. 2000 Feb;214(2):453-66
references.pmid: 10671594
references.citation: J Physiol. 2008 Oct 1;586(19):4721-33
references.pmid: 18687717
references.citation: JACC Cardiovasc Imaging. 2010 Oct;3(10):1001-9
references.pmid: 20947045
references.citation: Br J Sports Med. 2008 Jan;42(1):31-5; discussion 35
references.pmid: 17548371
references.citation: Eur J Echocardiogr. 2009 Jun;10(4):527-31
references.pmid: 19174444
references.citation: Magn Reson Med. 2009 Jul;62(1):77-84
references.pmid: 19322795
references.citation: J Am Soc Echocardiogr. 2006 Oct;19(10):1280-5
references.pmid: 17000368
references.citation: Br Heart J. 1981 Mar;45(3):248-63
references.pmid: 7008815