Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation.
OBJECTIVE
The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes.


RESULTS
A total of 36 top-level male endurance athletes (AT) and 36 age-matched sedentary normal controls (NC) underwent standard and real-time 3D echocardiography. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were assessed using 3D STE. AT had significantly higher GLS (-22.1 ± 4.4 vs. -18.4 ± 3.5%; P < 0.0001), GCS (-17.9 ± 2.4 vs. -16.0 ± 3.2; P = 0.006), and GAS (-35.5 ± 6.7 vs. -30.2 ± 4.9; P < 0.0001), while GRS did not differ significantly with NC. At separate multiple linear regression analyses, heart rate emerged as independent predictor of GLS (β = -0.37, P < 0.002), GCS (β = -0.32, P = 0.007), GAS (β = -0.37, P < 0.001), and GRS (β = -0.29, P = 0.019); LV mass was independently associated with GLS (β = 0.34, P = 0.009) and GAS (β = 0.41, P < 0.001) but not with GCS and GRS, while diastolic blood pressure predicted GCS (β = -0.46, P < 0.0001), GAS (β = -0.28; P = 0.006), and GRS (β = -0.42, P < 0.001). No independent correlation emerged for body surface area and stroke volume. By replacing LV mass with end-diastolic volume, the latter showed independent association with GCS (β = -0.65, P = 0.028) and with GRS (β = -0.60, P < 0.05).


CONCLUSIONS
AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres. Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal myocardial deformation at rest.
Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5, bld 1, 80131 Naples, Italy.
Francesco
F
Lo Iudice
Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5, bld 1, 80131 Naples, Italy.
Marta
M
Petitto
Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5, bld 1, 80131 Naples, Italy.
Marco
M
Ferrone
Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy.
Roberta
R
Esposito
Department of Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Andrea
A
Vaccaro
Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy.
Agostino
A
Buonauro
Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
Antonello
A
D'Andrea
Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5, bld 1, 80131 Naples, Italy.
Bruno
B
Trimarco
Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5, bld 1, 80131 Naples, Italy.
Maurizio
M
Galderisi
D000328:Adult; D056352:Athletes; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000502:physiology; D010807:Physical Endurance / Q000502:physiology*; D012016:Reference Values; D057185:Sedentary Behavior; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult
athlete's heart; heart rate; left ventricular mass; strain; three-dimensional speckle tracking echocardiography