Analysis of athletes' heart by tissue Doppler and strain/strain rate imaging

After regular and prolonged training, some physical and structural changes occur in the heart. Strain (S) imaging and Strain Rate (SR) imaging are new and effective techniques derived from tissue Doppler imaging (TDI) which examine systolic and diastolic functions. The aim of the present study was to evaluate left ventricular TDI and S/SR imaging properties in athletes and sedentary controls. The study population consisted of 26 highly trained athletes (group I) and age, sex and body mass index (BMI) adjusted 23 control subjects (group II) who had no pathological conditions. Using standard transthoracic and Doppler echocardiographical measurements and reconstructed spectral pulsed wave tissue Doppler velocities, the S/SR imaging of six different myocardial regions were evaluated. There was a significant increase in left ventricular systolic (LVSD) and diastolic (LVDD) diameter, inter-ventricular septum (IVS), left ventricular mass (LVm), left atrial diameter (LA), and transmitral Doppler peak E velocity (flow velocity in early diastole) between group I and group II in the case of echocardiographic findings. In athletes, TDI analysis showed a significantly increased mitral annulus lateral TDI peak early diastolic (E) velocity (18.8 ± 4.1 cm/s vs. 15 ± 3.5 cm/s, P < 0.01), septal TDI peak E velocity (15.8 ± 2.8 cm/s vs. 12.8 ± 2.4 P < 0.001). There were no significant differences in myocardial velocity imaging parameters between group I and group II. Peak systolic strain/strain rates of septal and lateral walls in group I were significantly higher than group II. This study demonstrates that left ventricular S/SR imaging was higher in athletes than in healthy subjects. In addition to traditional echocardiographic parameters, SI/SRI could be utilised as a useful echocardiographic method for cardiac functions of athletes.