title: Novel echocardiographic techniques for the evaluation of athletes' heart: A focus on speckle-tracking echocardiography.
abstract: BACKGROUND
  The development and rapid dissemination of two-dimensional echocardiography led to important further advances in our understanding of athletes' heart that has been the subject of several echocardiographic studies involving many thousands of athletes. The description of ventricular chamber enlargement, myocardial hypertrophy and atrial dilatation has led to a more comprehensive understanding of cardiac adaptation to exercise conditioning. Most recently, advanced echocardiographic techniques have begun to clarify significant functional adaptations of the myocardium that accompany previously reported morphological features of athletes' heart. In particular, speckle-tracking echocardiography (STE) has recently provided further insights into the characterisation of myocardial properties.
  
  
  CONCLUSIONS
  STE is a relatively new, largely angle-independent, non-invasive imaging technique that allows for an objective and quantitative evaluation of global and regional myocardial function. STE has enhanced our understanding of athletes' heart through a comprehensive characterisation of biventricular and biatrial function, providing novel insights into the investigation of physiological adaptation of the heart to exercise conditioning. These peculiarities can provide further useful data to distinguish between athletes' heart and cardiomyopathies. Furthermore, STE represents a promising tool to address new concerns on right ventricular function and to increase understanding of the complexity of the non-systemic circulation, especially in the athletic population.
  
  
  CONCLUSIONS
  This review article analyses new data on cardiac function in athletes by novel echocardiographic techniques with a particular attention to the application of STE to characterise biventricular and biatrial function in athletes.
authors.affiliation: Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy flavio.dascenzi@unisi.it.
authors.forename: Flavio
authors.initials: F
authors.lastname: D'Ascenzi
authors.affiliation: Institute of Sports Medicine and Science, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Caselli
authors.affiliation: Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solari
authors.affiliation: Institute of Sports Medicine and Science, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pelliccia
authors.affiliation: Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.affiliation: Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Focardi
authors.affiliation: Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Padeletti
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
authors.affiliation: Department of Medicine, Surgery and NeuroScience, University of Siena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bonifazi
authors.affiliation: Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
mesh_terms: D000222:Adaptation, Physiological; D056352:Athletes; D004452:Echocardiography / Q000379:methods*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D066253:Vascular Remodeling; D016278:Ventricular Function, Right
keywords: Imaging; athletes; exercise; remodelling; strain