Myocardial Strain Imaging in Asian Competitive Athletes – A Single Centre Study
American Journal of Sports Science
Volume 8, Issue 1, March 2020, Pages: 17-21
Received: Jan. 24, 2020; Accepted: Mar. 9, 2020; Published: Mar. 23, 2020
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Yann Shan Keh, Department of Cardiology, Changi General Hospital, Singapore; Department Cardiology, National Heart Centre, Singapore
Puay Joo Tan, Department of Cardiology, Changi General Hospital, Singapore
Siang Chew Chai, Department of Cardiology, Changi General Hospital, Singapore
Benedict Tan, Department of Sports Medicine, Changi General Hospital, Singapore
Khim Leng Tong, Department of Cardiology, Changi General Hospital, Singapore
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To date there has been limited literature pertaining to Athlete’s Heart Syndrome in Asian athletes, especially for those in South East Asia. We performed a single center cross-sectional case-control study of elite athletes and controls, using current speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. We reanalyzed previous data to further characterize the biomechanical changes in exercise induced cardiac remodeling elite athletes and controls at a tertiary hospital in Singapore. The Left Ventricular (LV) strain of the athletes’ group was significantly lower as compared to the control group (-19.0±2.0 vs -20.3±1.8, p=0.011). Furthermore, both LV torsion (14.3±17.8°/s vs 14.4±6.7°/s, p=0.031) and Lateral S’ (7.21±1.4 vs 8.7±1.6, p=0.001) showed small but statistically significant decreases in the athletes’ group versus the controls. The athletes group demonstrated a significantly lower Basal Right Ventricular (RV) free wall strain as compared to the controls (-19.8±5.5 vs -26.5±6.4 P < 0.001). The mid RV strain was marginally higher in the athletes’ group versus the controls (-25.0±4.3 vs -24.7±15.3 P=0.023). Our findings of impaired LV strain and torsion as well basal RV free walls strain in the South East Asian athletes group mirror studies done in Western cohorts. The higher mid RV free wall strain could represent compensatory response to the impaired basal RV function in athletes.
Speckle-Tracking Echocardiography, Tissue Doppler Imaging, Athlete’s Heart Syndrome, Exercise Induced Cardiac Remodeling, Asian Athletes
To cite this article
Yann Shan Keh, Puay Joo Tan, Siang Chew Chai, Benedict Tan, Khim Leng Tong, Myocardial Strain Imaging in Asian Competitive Athletes – A Single Centre Study, American Journal of Sports Science. Vol. 8, No. 1, 2020, pp. 17-21. doi: 10.11648/j.ajss.20200801.13
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Baggish AL, Wood MJ. Athlete's heart and cardiovascular care of the athlete: scientific and clinical update. Circulation. 2011; 123 (23): 2723-35.
D'Andrea A, Bossone E, Radmilovic J, Caso P, Calabro R, Russo MG, et al. The role of new echocardiographic techniques in athlete's heart. F1000Res. 2015; 4: 289.
Caso P, D'Andrea A, Galderisi M, Liccardo B, Severino S, De Simone L, et al. Pulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and myocardial regional diastolic function. The American journal of cardiology. 2000; 85 (9): 1131-6.
Tumuklu MM, Ildizli M, Ceyhan K, Cinar CS. Alterations in left ventricular structure and diastolic function in professional football players: assessment by tissue Doppler imaging and left ventricular flow propagation velocity. Echocardiography. 2007; 24 (2): 140-8.
Lewis JF, Spirito P, Pelliccia A, Maron BJ. Usefulness of Doppler echocardiographic assessment of diastolic filling in distinguishing "athlete's heart" from hypertrophic cardiomyopathy. Br Heart J. 1992; 68 (3): 296-300.
Richand V, Lafitte S, Reant P, Serri K, Lafitte M, Brette S, et al. An ultrasound speckle tracking (two-dimensional strain) analysis of myocardial deformation in professional soccer players compared with healthy subjects and hypertrophic cardiomyopathy. The American journal of cardiology. 2007; 100 (1): 128-32.
Keh YS, Tan PJ, Chai SC, Tan B, Tong KL. Physiologic Limits of Cardiac Remodelling in Asian Competitive Athletes - A Single Centre Study. Ann Acad Med Singapore. 2018; 47 (6): 230-2.
Santoro A, Alvino F, Antonelli G, Caputo M, Padeletti M, Lisi M, et al. Endurance and Strength Athlete's Heart: Analysis of Myocardial Deformation by Speckle Tracking Echocardiography. J Cardiovasc Ultrasound. 2014; 22 (4): 196-204.
von Lueder TG, Hodt A, Gjerdalen GF, Steine K. Left ventricular biomechanics in professional football players. Scand J Med Sci Sports. 2018; 28 (1): 187-95.
Demirelli S, Sam CT, Ermis E, Degirmenci H, Sen I, Arisoy A, et al. Long-Term Cardiac Remodeling in Elite Athletes: Assessment by Tissue Doppler and Speckle Tracking Echocardiography. Echocardiography. 2015; 32 (9): 1367-73.
Nottin S, Doucende G, Schuster I, Tanguy S, Dauzat M, Obert P. Alteration in left ventricular strains and torsional mechanics after ultralong duration exercise in athletes. Circulation Cardiovascular imaging. 2009; 2 (4): 323-30.
Simsek Z, Hakan Tas M, Degirmenci H, Gokhan Yazici A, Ipek E, Duman H, et al. Speckle tracking echocardiographic analysis of left ventricular systolic and diastolic functions of young elite athletes with eccentric and concentric type of cardiac remodeling. Echocardiography. 2013; 30 (10): 1202-8.
Esch BT, Scott JM, Haykowsky MJ, Paterson I, Warburton DE, Cheng-Baron J, et al. Changes in ventricular twist and untwisting with orthostatic stress: endurance athletes versus normally active individuals. J Appl Physiol (1985). 2010; 108 (5): 1259-66.
McClean G, George K, Lord R, Utomi V, Jones N, Somauroo J, et al. Chronic adaptation of atrial structure and function in elite male athletes. European heart journal cardiovascular Imaging. 2015; 16 (4): 417-22.
D'Andrea A, La Gerche A, Golia E, Teske AJ, Bossone E, Russo MG, et al. Right heart structural and functional remodeling in athletes. Echocardiography. 2015; 32 Suppl 1: S11-22.
La Gerche A, Burns AT, D'Hooge J, Macisaac AI, Heidbuchel H, Prior DL. Exercise strain rate imaging demonstrates normal right ventricular contractile reserve and clarifies ambiguous resting measures in endurance athletes. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography. 2012; 25 (3): 253-62 e1.
La Gerche A, Burns AT, Mooney DJ, Inder WJ, Taylor AJ, Bogaert J, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. European heart journal. 2012; 33 (8): 998-1006.
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