Left ventricular biomechanics in professional football players

Abstract

Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle‐tracking echocardiography (STE) and tissue Doppler imaging (TDI)‐based techniques. A total of 103 consecutive male elite Norwegian soccer players and 46 age‐matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans‐mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by color M‐mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base‐to‐apex gradient of LS. Color M‐mode and TDI‐derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4±2.8 vs controls 101.9±5.2 deg/s, P<.01). Diastolic untwisting rate (UTWR) was higher in players (−124.5±4.2 vs −106.9±6.7 deg/s) and peaked earlier during the cardiac cycle (112.7±0.8 vs 117.4±2.4% of systole duration, both P<.05). Untwisting/twisting ratio (−1.48±0.05 vs −1.11±0.08; P<.001) and untwisting performance (=UTR/TW; −9.25±0.34 vs −7.38±0.40 s−1, P<.01) were increased in players. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players, was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete′s heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy.