Left ventricular longitudinal strain in professional athletes, a useful tool to detect an athletes hearts?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Bewarder ◽  
S Kulenthiran ◽  
O Schaefer ◽  
L Lauder ◽  
C Ukena ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Endurance Exercise ◽  
Longitudinal Strain ◽  
Ventricular Hypertrophy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Soccer Players ◽  
Professional Athletes ◽  
Healthy Controls ◽  
Professional Soccer

Abstract Background Professional cyclists frequently present with physiological adaptations to endurance exercise with an increase in left ventricular wall thickness and mass. Global longitudinal strain (GLS) is an early and sensitive echocardiographic method to detect left ventricular dysfunction. However, it is unclear whether GLS is able to differentiate between athlete's hearts or different pathological conditions of left ventricular hypertrophy. Methods A total of 87 professional athletes (37 professional cyclists, 29 professional soccer players, and 21 professional handball players) were compared to 125 patients with different forms of left ventricular hypertrophy (17 hypertrophic obstructive cardiomyopathy (HOCM), 36 hypertensive heart disease (HHD), 35 severe aortic valve stenosis (AVS); 37 untrained individuals served as controls. Examinations were performed between October 2018 to October 2019. All subjects underwent echocardiographic examination, including GLS. Results In all 212 participants/patients included a preserved ejection fraction >50% (mean 61±7%) was detected. Left ventricular mass index (LVMI) in professional cyclists (165.5±37.1 g/m2) was increased when compared to professional soccer players (97.3±12.4 g/m2, p<0.001), professional handball players (92.2±15.8 g/m2, p<0.001) and healthy controls (94.3±20.7 g/m2, p<0.001), as well as to patients with HHD (129.2±30.0 g/m2, p<0.001), or AVS (140.1±35.4 g/m2, p=0.064), but not to patients with HOCM (159.7±39.4 g/m2, p=0.64). Professional cyclists (−21.0±3.5%) achieved higher average GLS values than professional soccer (−18.4 ± %, p=0.004) or handball players (−18.4 ± %, p=0.021), healthy controls (−19.0±3.0%, p=0.008), HOCM (−15.0±6.5%, p<0.001), HHD (−13.8±5.9%, p<0.001), and AVS (−16.0±7.0%, p<0.001) (Figure 1). Conclusion In professional cyclists, higher LVMI and average GLS values were detected compared to professional soccer and handball players with lower excessive endurance exercise, as well as untrained healthy controls. Average GLS can help to differentiate between athletes' hearts in professional cyclists compared to pathologic patterns in different diseases characterized by left ventricular hypertrophy with elevated LVMI. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality

2021 ◽  
Vol 25 (12) ◽  
pp. 863-871
Author(s):  
Pelin Karaca Özer ◽  
◽  
Elif Ayduk Gövdeli ◽  
Berat Engin ◽  
Adem Atıcı ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Longitudinal Strain ◽  
Ventricular Hypertrophy ◽  
Global Longitudinal Strain ◽  
Left Ventricular

scholarly journals Deformation of the left heart chambers in hypertensive postmenopausal women, depending on the presence of left ventricular hypertrophy and left atrium dilation

2019 ◽  
Vol 26 (3) ◽  
pp. 17-26
Author(s):  
M. Yu. Kolesnyk ◽  
M. V. Sokolova
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Postmenopausal Women ◽  
Longitudinal Strain ◽  
Ventricular Hypertrophy ◽  
Blood Pressure Monitoring ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Heart ◽  
Hypertensive Patients ◽  
Healthy Women

The aim – to assess the longitudinal deformation (strain) of the left heart chambers in postmenopausal women with essential hypertension (EH), depending on the presence of left ventricular hypertrophy (LVH) and left atrial (LA) dilation. Materials and methods. The study involved 126 postmenopausal women: 100 patients with EH I–II stages of the main group and 26 practically healthy women of the comparison group. Patients with EH were divided into two groups: 32 patients without structural changes of the myocardium and 68 women with LVH and/or LA dilation. In all patients we performed ambulatory blood pressure monitoring, standard transthoracic echocardiography and speckle-tracking echocardiography. The global longitudinal strain (GLS) of LV and deformation of the endocardial (endo), middle (mid) and epicardial (epi) layers of myocardium were analyzed. Analysis of LA deformation was performed using two (from the beginning of the R-wave and from the apex of the R-wave) variants of ECG-synchronization. The LA longitudinal strain (LS) was evaluated in reservoir and contraction phase in two positions with the calculation of the GLS LA. Results and discussion. We found changes in LV multilayer deformation as LS decreasing in the endocardial, middle and epicardial layers in hypertensive patients in the early stages of disease, even before the development of LVH. Damage of LA deformation preceded its dilation. Both types of ECG-synchronization showed a statistically significant decrease of LA strain in the reservoir phase in all hypertensive patients in comparison with healthy women. A decreasing LA GLS in women with EH and structurally normal heart compared to the healthy group was detected only by using ECG-synchronization with R-wave, which is considered more universal. Conclusion. A decrease of LA and LV LS in postmenopausal women is recorded even before the development of LVH and LA dilation. The LV LS became lower in all layers of myocardium – from endocardial to epicardial. Changes in the LA LS in postmenopausal women with EH begin with a damage of reservoir phase even with normal size of LA and a LV myocardial mass index.

Correlation between Global Longitudinal Strain and QRS Voltage on Electrocardiogram in Patients with Left Ventricular Hypertrophy

2013 ◽  
Vol 31 (3) ◽  
pp. 325-334 ◽  
Author(s):  
Carmen C. Beladan ◽  
Bogdan A. Popescu ◽  
Andreea Calin ◽  
Monica Rosca ◽  
Florin Matei ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Longitudinal Strain ◽  
Ventricular Hypertrophy ◽  
Global Longitudinal Strain ◽  
Left Ventricular

Abstract 4130: Applicability Of Left Ventricular Hypertrophy Electrocardiographic Criteria In Professional Athletes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Nelson Samesima ◽  
Carlos A Pastore ◽  
Luciana D de Matos ◽  
Fernanda F Fumagalli ◽  
Mariane V Ferreira ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Statistical Significance ◽  
False Negative ◽  
Left Ventricular ◽  
False Positives ◽  
Professional Athletes ◽  
Categorical Variables ◽  
S Wave ◽  
S Waves

Introduction. The widely known electrocardiographic criteria for diagnosing left ventricular hypertrophy (LVH) use QRS complex voltages to define whether there is left ventricle enlargement or not. Mild myocardial hypertrophy is detected in many professional athletes and this is a consequence of their daily intensity of training. Thus it is not unusual that athlete’s ECGs show large QRS voltages with normal hearts. Objective. To evaluate the applicability of the usual electrocardiographic criteria for LVH - Sokolow-Lyon, Romhilt-Estes, Cornell and Gubner - in a population of professional athletes. Methods. The four LVH criteria for diagnosing LVH were applied to analyse ECGs of 107 professional athletes (71% soccer players, 29% marathonists, all male, age 25± 10 years, training for 9± 8 years) by the same observer unaware of echocardiographic results. ECG was considered to be indicative of LVH if: Sokolow-Lyon ≥35mm (V 1or 2 S wave+V 5or 6 R wave); Romhilt-Estes score ≥5 points (frontal plane: R or S waves ≥ 20mm, horizontal plane: R or S waves ≥ 30mm, Morris indices, V 5or 6 strain pattern, left axis deviation ≥ − 30°, intrinsecoid deflection ≥ 0.04s, QRS duration ≥ 0.10s) ; Cornell ≥ 28mm (aV L R wave + V 3 S wave); Gubner ≥ 22mm (D I R wave + D III S wave). Hypertrophy was considered whenever: LV diastolic diameter ≥ 60mm and/or septum ≥ 13mm and/or LV posterior wall ≥ 13mm. Kruskal-Wallis was used to statistically analyse quantitative variables, corrected chi-square test for categorical variables. Significance level: p ≤ 0.05. Results. Romhilt-Estes showed the best results (75% sensitivity, 84% specificity, 16 false-positives, 1 false-negative), and was the only criteria with statistical significance (p = 0.047). Sokolow-Lyon showed 100% sensitivity, 15% specificity, p = 0.545, 88% false-positives, 0% false-negative. Cornell and Gubner showed 25% and 0% sensitivity, 95% and 99% specificity, p=0.205 and p = 0.449, respectively. Conclusion. In this male population of professional athletes, Romhilt-Estes score proved to be the best criterion for identifying left ventricular hypertrophy, while Sokolow-Lyon criterion did not discriminate normal from abnormal hearts. Cornell and Gubner criteria should not be used in this population because of their low sensitivity.

Abstract 17246: Sensitivity and Specificity of Relative Sparing of Apical Longitudinal Strain for Detection of Systemic Light-Chain Amyloidosis versus Transthyretin Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Jiang ◽  
Julia M Simkowski ◽  
Nadia El Hangouche ◽  
Jeesoo Lee ◽  
Milica Marion ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Sensitivity And Specificity ◽  
Light Chain ◽  
Longitudinal Strain ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Control Group ◽  
Transthyretin Amyloidosis ◽  
Light Chain Amyloidosis ◽  
Significant Difference

Introduction: Relative apical sparing of longitudinal strain (RALS, the ratio of apical strain vs the rest of the heart) on echocardiography has been found to have high sensitivity and specificity for differentiating cardiac amyloidosis (CA) from other causes of left ventricular hypertrophy. Previous studies have shown no significant difference between amyloid subtypes, systemic light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR) Hypothesis: There will be a significant difference in sensitivity and specificity of RALS to detect CA across amyloid subtypes. Methods: A cohort of patients with either AL or ATTR amyloid was identified, with a control cohort of patients with left ventricular hypertrophy (LVH) of other etiologies. Speckle tracking echocardiography was performed on EchoPAC (GE Medical Systems) software to obtain values of basal, mid, and apical longitudinal strain for each patient; relative apical strain was then calculated. Results: The TTR group (n=22) was older (66.4±7.9, 76.6±11.6, p=0.001) and more likely to be female (p=0.009) than the AL group (n=30), both groups had similar rates of hypertension, diabetes mellitus, and end stage renal disease. Echocardiographic markers of diastolic function were decreased in both groups; the AL group had decreased left ventricle end diastolic volume (60.9±25.5, 94.9±50.2, p=0.012) and mean wall thickness (1.4±0.3, 1.6±0.4 p=0.017). ROC analysis using a RALS cutoff of 2 to differentiate AL and ATTR from the LVH control group revealed similar specificity (AL 85%, ATTR 85%) and sensitivity (AL 40%, ATTR 50%). Difference in area-under-curve (AUC) was not significant (p=0.2) (figure). Conclusions: ATTR and AL amyloid have similar specificity, but ATTR has a trend towards improved sensitivity over AL for detection of CA using RALS with the previously validated threshold of 2. This might become significant with a larger sample, work that is currently on-going..

scholarly journals Myocardial Metabolism in Endurance Exercise-Induced Left Ventricular Hypertrophy

2018 ◽  
Vol 11 (6) ◽  
pp. 928-930
Author(s):  
Meagan M. Wasfy ◽  
Courtney Foster Bibbo ◽  
Marcel Brown ◽  
James R. DeLuca ◽  
Francis Wang ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Endurance Exercise ◽  
Ventricular Hypertrophy ◽  
Myocardial Metabolism ◽  
Left Ventricular ◽  
Exercise Induced

scholarly journals P970 Significant differences in atrial structural and functional parameters leading to differing mechanisms of atrial fibrillation in athletes compared to non-athletes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Trivedi ◽  
G Claessen ◽  
L Stefani ◽  
D Flannery ◽  
P Brown ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Healthy Controls ◽  
Age And Gender ◽  
History Of ◽  
And Gender

Abstract Background/Introduction: There is an increased incidence of atrial fibrillation (AF) in endurance athletes. We sought to evaluate the likely mechanistic basis for this phenomenon. Methods 36 endurance athletes in sinus rhythm, with a previous history of AF (ATH-AF) were compared to age and gender matched endurance athletes with no prior history of AF (ATH), non athletes with paroxysmal AF (NONATH-AF) and age and gender matched healthy controls (CONTROL). A detailed transthoracic echocardiogram was performed with all groups in sinus rhythm, with detailed left atrial (LA) and left ventricular (LV) measurements, including strain analysis. Results All athletes had increased LA and LV size when compared with healthy controls (Table 1). Non athletes with paroxysmal AF had increased LA size when compared with controls. However, indexed LA/LV ratio was preserved in athletes and similar to healthy individuals, whilst AF patients had significantly increased LA/LV ratio. Athletes with AF had higher e’ velocity and lower E/e’, whereas e’ was reduced and E/e’ elevated in non-athlete AF patients. Athletes had impaired LA reservoir and contractile strain, and reduced LV global longitudinal strain (GLS) compared with healthy controls. Conclusions Compared to healthy controls, athletes have reduced LA and LV strain, with preserved LV diastolic function and LA/LV ratio. In contrast, altered diastolic function with differential increase in LA volume was observed in AF patients. The increased risk of AF in athletes is likely mediated by different mechanistic processes other than an atrial myopathy consequent to diastolic dysfunction as observed in non-athletes with AF. Table 1. LA and LV parameters Parameter ATH-AF ATH NONATH-AF CONTROL P value LVEDV indexed (ml/m2) 84 ± 12 79 ± 14 57 ± 10 51 ± 13 <0.001 LVESV indexed (ml/m2) 35 ± 6 34 ± 7 25 ± 8 27 ± 33 0.02 LV ejection fraction (%) 58 ± 4 56 ± 4 56 ± 10 58 ± 8 0.586 LV global longitudinal strain (%) 19.2 ± 1.7 18.9 ± 2.1 21 ± 3.1 21.7 ± 2.9 <0.001 e’ vel (cm/s) 10 ± 2 10 ± 3 8 ± 2 9 ± 2 0.007 E/e’ 5.7 ± 1.3 5.9 ± 1.8 9.1 ± 3.3 7.5 ± 1.5 <0.001 LAV max indexed (ml/m2) 45 ± 11 43 ± 12 38 ± 11 27 ± 8 <0.001 Indexed LAV/LVEDV ratio 0.5 ± 0.1 0.6 ± 0.2 0.7 ± 0.2 0.5 ± 0.1 <0.001 LA reservoir strain (%) 27.2 ± 4.8 28.2 ± 3.7 27.9 ± 8.4 33.2 ± 7.0 <0.001 LA conduit strain (%) 14.2 ± 4.5 14.4 ± 4.0 14.9 ± 5.5 16.6 ± 6.3 0.182 LA contractile strain (%) 13.0 ± 3.1 13.8 ± 3.6 13.0 ± 5.1 16.6 ± 3.1 <0.001 LV = left ventricular, LAV = left atrial volume, LA = left atrial

Sign in / Sign up

Export Citation Format

Share Document