D'Andrea Antonello, Caso Pio, Sarubbi Berardo, Limongelli Giuseppe, Liccardo Biagio, Cice Gennaro, D'Andrea Luigi, Scherillo Marino, Cotrufo Maurizio, Calabrò Raffaele
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples and Division of Cardiology, V. Monaldi Hospital, Naples, Italy.
Echocardiography. 2003 May;20(4):329-36. doi: 10.1046/j.1540-8175.2003.03038.x.
The aim of this study was to analyze right ventricular (RV) myocardial function in competitive athletes with left ventricular (LV) hypertrophy induced by either endurance or strength training.
Standard Doppler echo, maximal electrocardiogram (ECG) ergometric test, and pulsed tissue Doppler (TD) of LV mitral annulus and of RV tricuspid annulus were performed in 32 competitive endurance athletes (long-distance swimmers; ATE) and in 26 strength-trained athletes (short-distance swimmers; ATS), all males. By use of TD, the following parameters of myocardial function were assessed: systolic peak velocities (Sm), precontraction time, contraction time, early (Em) and late (Am) diastolic velocities, Em/Am ratio, and relaxation time.
The two groups were comparable for age, but ATS at rest exhibited higher heart rate, systolic blood pressure, and body surface area. LV mass index did not significantly differ between the two groups. However, ATS characterized increased wall thickness and relative wall thickness, whereas LV stroke volume and both LV and RV end-diastolic diameters were greater in ATE. All transmitral and transtricuspid Doppler indexes were higher in ATE, with increased E/A ratios. TD analysis demonstrated in ATE higher Em and Em/Am ratio as well as longer relaxation time both at mitral and at tricuspid annulus level. In the overall population, distinct multiple linear regression models evidenced independent positive association between RV peak Em velocity and LV end-diastolic diameter (P < 0.001) as well as independent direct correlation of the same RV peak Em velocity with both LV stroke volume and maximal workload achieved by bicycle ergometer (both P < 0.001).
Right ventricular early diastolic myocardial function is positively influenced by preload increase in athletes, and represents an independent determinant of cardiac performance during physical effort. Therefore, pulsed TD may be taken into account to distinguish different cardiac adaptation to either endurance or strength sport activities, and eventually to quantify RV adaptation degree to long-term training.
本研究旨在分析因耐力训练或力量训练导致左心室（LV）肥厚的竞技运动员的右心室（RV）心肌功能。
对32名竞技耐力运动员（长跑运动员；ATE）和26名力量训练运动员（短跑运动员；ATS）进行标准多普勒超声心动图、最大心电图（ECG）运动试验以及左心室二尖瓣环和右心室三尖瓣环的脉冲组织多普勒（TD）检查，所有受试者均为男性。通过TD评估心肌功能的以下参数：收缩期峰值速度（Sm）、预收缩时间、收缩时间、舒张早期（Em）和晚期（Am）速度、Em/Am比值以及舒张时间。
两组年龄相当，但ATS静息时心率、收缩压和体表面积较高。两组左心室质量指数无显著差异。然而，ATS的特点是室壁厚度和相对室壁厚度增加，而ATE的左心室每搏量以及左心室和右心室舒张末期直径更大。ATE的所有二尖瓣和三尖瓣多普勒指标均较高，E/A比值增加。TD分析显示，ATE在二尖瓣和三尖瓣环水平的Em和Em/Am比值较高，舒张时间较长。在总体人群中，不同的多元线性回归模型表明，右心室Em峰值速度与左心室舒张末期直径之间存在独立的正相关（P<0.001），并且相同的右心室Em峰值速度与左心室每搏量以及自行车测力计达到的最大工作量均存在独立的直接相关性（均P<0.001）。
运动员前负荷增加对右心室舒张早期心肌功能有积极影响，并且是体力活动期间心脏功能的独立决定因素。因此，可考虑使用脉冲TD来区分对耐力或力量运动活动的不同心脏适应性，并最终量化右心室对长期训练的适应程度。
