E. Colne , N. Pace , A. Fraix , C. Selton-Suty , B. Chenuel , N. Sadoul , E. Aliot , N. Girerd , Z. Lamiral , J. Felloni , K. Djaballah , L. Filippetti , O. Huttin
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This study sought to identify echocardiographic phenotype of endurance athletes using 2D speckle tracking imaging with a multi-layer approach and to define predictive factors of subtle LV </span></span>systolic dysfunction.</p></div><div><h3>Method</h3><p>Healthy male athletes who underwent a pre-participation medical evaluation at the University Hospital of Nancy between 2013 and 2020 were included. Clinical and echocardiographic data were compared with healthy men from the STANISLAS cohort. Subtle LV dysfunction was defined as a GLS < 17.5%.</p></div><div><h3>Results</h3><p>A total of 191 athletes and 161 control subjects were studied. Athletes demonstrated lower LVEF (57.9% vs. 62.6%; <em>P</em> <!--><<!--> <!-->0.01) and lower GLS (17.8% vs. 21.1%; <em>P</em> <!--><<!--> <span>0.01). No significant differences were found between athletes with and without subtle LV dysfunction regarding clinical characteristics, structural echocardiographic features, and exercise capacity. Athletes with subtle LV dysfunction exhibited a lower endocardial GLS (18.8% vs. 22.7%; </span><em>P</em> <!--><<!--> <!-->0.02), a lower epicardial GLS (14.0% vs. 16.6%; <em>P</em> <!--><<!--> <!-->0.01) and a greater endocardial/epicardial GLS ratio (1.36 vs. 1.32; <em>P</em> <!--><<!--> <!-->0.01). No significant difference was found regarding mechanical dispersion (<em>P</em> <!-->=<!--> <!-->0.46).</p></div><div><h3>Conclusion</h3><p>The endurance athlete's heart is characterized by a specific myocardial deformation pattern with a greater endocardial/epicardial GLS ratio. Subtle LV dysfunction seems mainly driven by a decreased epicardial GLS and not related to exercise capacity, structural remodelling or mechanical dispersion (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Pages 249-250"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Advanced myocardial deformation echocardiography for the athlete's heart evaluation: Functional and mechanistic analysis\",\"authors\":\"E. Colne , N. Pace , A. Fraix , C. Selton-Suty , B. Chenuel , N. Sadoul , E. Aliot , N. Girerd , Z. Lamiral , J. Felloni , K. Djaballah , L. Filippetti , O. 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Clinical and echocardiographic data were compared with healthy men from the STANISLAS cohort. Subtle LV dysfunction was defined as a GLS < 17.5%.</p></div><div><h3>Results</h3><p>A total of 191 athletes and 161 control subjects were studied. Athletes demonstrated lower LVEF (57.9% vs. 62.6%; <em>P</em> <!--><<!--> <!-->0.01) and lower GLS (17.8% vs. 21.1%; <em>P</em> <!--><<!--> <span>0.01). No significant differences were found between athletes with and without subtle LV dysfunction regarding clinical characteristics, structural echocardiographic features, and exercise capacity. Athletes with subtle LV dysfunction exhibited a lower endocardial GLS (18.8% vs. 22.7%; </span><em>P</em> <!--><<!--> <!-->0.02), a lower epicardial GLS (14.0% vs. 16.6%; <em>P</em> <!--><<!--> <!-->0.01) and a greater endocardial/epicardial GLS ratio (1.36 vs. 1.32; <em>P</em> <!--><<!--> <!-->0.01). 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引用次数: 0
摘要
由于反应性生理适应和病理重构之间的表型重叠，对运动员心脏的超声心动图评估仍然具有挑战性。运动员左心室收缩射血分数(LVEF)和总纵向应变(GLS)正常值范围较低，这使得很难区分与适应性重构相关的变化或早期心肌病的指示性变化。本研究试图通过多层二维斑点跟踪成像技术确定耐力运动员的超声心动图表型，并确定微妙的左室收缩功能障碍的预测因素。方法选取2013 - 2020年在Nancy大学医院接受赛前医学评估的健康男性运动员为研究对象。将临床和超声心动图数据与来自STANISLAS队列的健康男性进行比较。轻度左室功能障碍定义为GLS <17.5%。结果共调查了191名运动员和161名对照组。运动员表现出较低的LVEF (57.9% vs. 62.6%;P & lt;0.01)和较低的GLS (17.8% vs. 21.1%;P & lt;0.01)。有和没有轻微左室功能障碍的运动员在临床特征、结构超声心动图特征和运动能力方面没有显著差异。有轻微左室功能障碍的运动员表现出较低的心内膜GLS (18.8% vs 22.7%;P & lt;0.02)，心外膜GLS较低(14.0% vs. 16.6%;P & lt;0.01)，心内膜/心外膜GLS比值更高(1.36 vs. 1.32;P & lt;0.01)。机械离散度差异无统计学意义(P = 0.46)。结论耐力运动员心脏具有特殊的心肌变形模式，心内膜/心外膜GLS比较大。轻微的左室功能障碍似乎主要是由心外膜GLS下降引起的，与运动能力、结构重塑或机械弥散无关(图1)。
Advanced myocardial deformation echocardiography for the athlete's heart evaluation: Functional and mechanistic analysis
Introduction
Echocardiographic assessment of the athlete's heart remains challenging because of a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The lower range of normal values of left ventricle systolic ejection fraction (LVEF) and global longitudinal strain (GLS) in athletes makes it difficult to differentiate changes related to adaptive remodelling or indicative of early cardiomyopathy. This study sought to identify echocardiographic phenotype of endurance athletes using 2D speckle tracking imaging with a multi-layer approach and to define predictive factors of subtle LV systolic dysfunction.
Method
Healthy male athletes who underwent a pre-participation medical evaluation at the University Hospital of Nancy between 2013 and 2020 were included. Clinical and echocardiographic data were compared with healthy men from the STANISLAS cohort. Subtle LV dysfunction was defined as a GLS < 17.5%.
Results
A total of 191 athletes and 161 control subjects were studied. Athletes demonstrated lower LVEF (57.9% vs. 62.6%; P < 0.01) and lower GLS (17.8% vs. 21.1%; P < 0.01). No significant differences were found between athletes with and without subtle LV dysfunction regarding clinical characteristics, structural echocardiographic features, and exercise capacity. Athletes with subtle LV dysfunction exhibited a lower endocardial GLS (18.8% vs. 22.7%; P < 0.02), a lower epicardial GLS (14.0% vs. 16.6%; P < 0.01) and a greater endocardial/epicardial GLS ratio (1.36 vs. 1.32; P < 0.01). No significant difference was found regarding mechanical dispersion (P = 0.46).
Conclusion
The endurance athlete's heart is characterized by a specific myocardial deformation pattern with a greater endocardial/epicardial GLS ratio. Subtle LV dysfunction seems mainly driven by a decreased epicardial GLS and not related to exercise capacity, structural remodelling or mechanical dispersion (Fig. 1).
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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