Global Longitudinal Strain in master athletes and in hypertensive patients with the same degree of septal thickness

Global longitudinal strain differentiates physiological hypertrophy from maladaptive remodeling

Aims

Differentiation of left ventricular (LV) hypertrophy in healthy athletes from pathological LV hypertrophy in heart disease is often difficult. We explored whether extended echocardiographic measurements such as E/e’ and global longitudinal strain (GLS) distinguish physiologic from maladaptive hypertrophy in hypertrophic cardiomyopathy, excessively trained athletes’ hearts and normal hearts.

Methods

Seventy-eight professional athletes (cyclists n = 37, soccer players n = 29, handball players n = 21) were compared with patients (n = 88) with pathological LV hypertrophy (hypertrophic obstructive cardiomyopathy (HOCM, n = 17), hypertensive heart disease (HHD, n = 36), severe aortic valve stenosis (AVS, n = 35) and with sedentary healthy individuals as controls (n = 37).

Results

LV ejection fraction (LVEF) was ≥50% in all patients, athletes (median age 26 years, all male) and the controls (97% male, median age 32 years). LV mass index (LVMI) and septal wall thickness was in normal range in controls, but elevated in cyclists and patients with pathological hypertrophy (p < 0.001 for both). E/e’ was elevated in all patients with maladaptive hypertrophy but normal in controls and athletes (p < 0.001 vs. pathological hypertrophy). Furthermore GLS was reduced in patients with pathological hypertrophy compared with athletes and controls (for both p < 0.001). In subjects with septal wall thickness >11 mm, GLS (≥−18%) has a specificity of 79% to distinguish between physiological and pathological hypertrophy.

Conclusion

GLS and E/e’ are reliable parameters unlike left ventricular mass or LV ejection fraction to distinguish pathological and physiological hypertrophy.

Strain echocardiography to describe left ventricular function pre- and postexercise in elite basketball athletes: A feasibility study

BACKGROUND

Elite athletes show structural cardiac changes as an adaptation to exercise. Studies examining strain in athletes have largely analyzed images at rest only. There is little data available regarding the change in strain with exercise. Our objectives were: to investigate the feasibility of strain analysis in athletes at peak exercise, to determine the normal range of left ventricular (LV) global longitudinal strain (GLS) within this population postexercise, to describe how LV GLS changes with exercise, and to determine whether any clinical characteristics correlate with the change in GLS that occurs with exercise.

METHODS

We conducted a cross-sectional study on elite athletes who participated in the 2016-2018 National Basketball Association Draft Combines. Echocardiograms were obtained at rest and after completing a treadmill stress test to maximal exertion or completion of Bruce protocol. Primary outcomes included GLS obtained at rest and peak exercise. Secondary outcome was the change in GLS between rest and exercise. Univariate relationships between various clinical characteristics and our secondary outcome were analyzed.

RESULTS

Our final cohort (n = 111) was all male and 92/111 (82.9%) were African American. Mean GLS magnitude increased in response to exercise (-17.6 ± 1.8 vs -19.2 ± 2.6, P < .0001). Lower resting heart rates (r = .22, P = .02) and lower heart rates at peak exercise (r = .21, P = .03) correlated with the increase in LV GLS from exercise.

CONCLUSIONS

Strain imaging is technically feasible to obtain among elite basketball athletes at peak exercise. Normative strain response to exercise from this study may help identify abnormal responses to exercise in athletes.

Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review

In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms. The search was refined by adding the keywords heart, sport, elite, master, children and young. Twenty-eight studies were selected for the final analysis. Our research revealed that currently available ranges of normality for athletes reported by different authors are quite consistent, with limited exceptions (e.g. atria, aorta). Numerical and methodological limitations, however, emerged. Numerical limitations included a limited sample size (e.g. < 450 subjects) of the population assessed and the paucity of data in women, non-Caucasian athletes, and junior and master athletes. Some data on M-mode measurements are available, while those for some specific structures (e.g. left atrial (LA) area and volumes, right ventricular diameters and aorta) are limited or rare (e.g. LA area). There was heterogeneity in data normalization (by gender, sport type and ethnicity) and their expression was limited to mean values (Z-scores have rarely been employed), while variability analysis was often lacking or incomplete. We conclude that comprehensive nomograms using an appropriate sample size, evaluating a complete dataset of 2D (and three-dimensional) measures and built using a rigorous statistical approach are warranted.

Body Mass Index in Master Athletes: Review of the Literature

Background

Masters athletes (MAs) have led a physically active lifestyle for an extended period of time or initiated exercise/sport in later life. Given the benefits of physical activity and exercise we investigated if body mass index (BMI), an indirect health indicator of obesity, was clinically superior in MAs as compared to controls or the general population.

Methods

Seven databases (Medline, PubMed, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane) were electronically searched for studies on BMI (kg/m²) or as a percentage of BMI categories (underweight, normal, overweight, obesity) in MAs.

Results

Of the initial yield of 7,431 papers, 60 studies met our inclusion criteria and were used in this literature review. Studies identified were classified as: endurance sports (n = 14), runners (n = 14), mixed sports (n = 8), cyclists (n = 4), soccer (n = 4) swimmers (n = 3), non-specific (n = 3), orienteering (n = 2), World Masters Games (n = 2) and individual sports (n = 5). Where BMI was presented for the group of MAs the mean was 23.8 kg/m² (± 1.1) with a range from 20.8 kg/m² (endurance runners) to 27.3 kg/m² (soccer players), this was significantly lower (p < 0.001) than controls ( −9.5%, 26.13 ± 1.7 kg/m²). Where gender specific BMI was reported the mean for male MAs was 23.6 kg/m² (± 1.5) (range 22.4 kg/m² endurance to 26.4 kg/m² swimmers) and 22.4 kg/m² (± 1.2) for female MAs (range 20.8 kg/m² mixed to 24.7 kg/m² WMG).

Conclusion

In most, but not all studies the BMI of MAs was significantly lower than controls. A clinically superior BMI affords MAs reduced risk with regard to a number of cardiometabolic diseases, osteoarthritis and certain types of cancers.