title: Patterns of left ventricular longitudinal strain and strain rate in Olympic athletes.
abstract: BACKGROUND
  Two-dimensional speckle-tracking echocardiography is an emerging modality for the assessment of systolic and diastolic myocardial deformation in a broad variety of clinical scenarios. However, normal values and physiologic limits of left ventricular strain and strain rate in trained athletes are largely undefined.
  
  
  METHODS
  Two hundred consecutive Olympic athletes (grouped into skill, power, mixed, and endurance disciplines) and 50 untrained controls were evaluated by two-dimensional speckle-tracking echocardiography. Left ventricular global systolic longitudinal strain (GLS), systolic strain rate, early diastolic strain rate (SRE) and late diastolic strain rate (SRA) were calculated.
  
  
  RESULTS
  GLS was normal, although mildly lower, in athletes compared with controls (-18.1 ± 2.2% vs -19.4 ± 2.3%, P < .001), without differences related to type of sport. Systolic strain rate was also lower in athletes (-1.00 ± 0.15 vs -1.11 ± 0.15 sec(-1), P < .001), with the lowest value in endurance disciplines (-0.96 ± 0.13 sec(-1), P < .001). No difference existed for SRE (1.45 ± 0.32 vs 1.51 ± 0.35 sec(-1), P = .277), while SRA was lower in athletes (0.67 ± 0.25 vs 0.81 ± 0.20 sec(-1), P < .001). Both SRE (1.37 ± 0.30 sec(-1), P < .001) and SRA (0.62 ± 0.23 sec(-1), P < .001) showed the lowest values in endurance disciplines. The fifth and 95th percentiles calculated as reference values in athletes were as follows: for GLS, -15% and -22%; for systolic strain rate, -0.8 and -1.2 sec(-1); for SRE, 1.00 and 2.00 sec(-1); and for SRA, 0.30 and 1.20 sec(-1).
  
  
  CONCLUSIONS
  The present study shows that highly trained athletes have normal GLS and strain rate parameters of the left ventricle, despite mild differences compared with untrained controls. These data may be implemented as reference values for the clinical assessment of the athletes and to support the diagnosis of physiologic cardiac adaptations in borderline cases.
authors.affiliation: Institute of Sports Medicine and Science, Rome, Italy. Electronic address: stefanocasellimd@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Caselli
authors.affiliation: Department of Molecular and Clinical Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Dalma
authors.initials: D
authors.lastname: Montesanti
authors.affiliation: Department of Molecular and Clinical Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Autore
authors.affiliation: Institute of Sports Medicine and Science, Rome, Italy.
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Di Paolo
authors.affiliation: Institute of Sports Medicine and Science, Rome, Italy.
authors.forename: Cataldo
authors.initials: C
authors.lastname: Pisicchio
authors.affiliation: Institute of Sports Medicine and Science, Rome, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Squeo
authors.affiliation: Department of Molecular and Clinical Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Musumeci
authors.affiliation: Institute of Sports Medicine and Science, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spataro
authors.affiliation: Cardiovascular Imaging and Hemodynamic Laboratory, Tufts University Medical Center, Boston, Massachusetts.
authors.forename: Natesa G
authors.initials: NG
authors.lastname: Pandian
authors.affiliation: Institute of Sports Medicine and Science, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pelliccia
mesh_terms: D000328:Adult; D056352:Athletes / Q000706:statistics & numerical data*; D054874:Athletic Performance / Q000502:physiology*; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D015588:Observer Variation; D010807:Physical Endurance / Q000502:physiology; D012016:Reference Values; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology; D055815:Young Adult
keywords: Athletes; Left ventricle; Speckle tracking; Strain; Strain rate