Dores Hélder, Mendes Lígia, Dinis Paulo, Cardim Nuno, Monge José Carlos, Santos José Ferreira
Armed Forces Hospital, Azinhaga dos Ulmeiros, 1649-020, Lisbon, Portugal.
Lisbon Luz Hospital, Avenida Lusíada, no 100, 1500-650, Lisbon, Portugal.
Int J Cardiovasc Imaging. 2018 Dec;34(12):1869-1875. doi: 10.1007/s10554-018-1412-3. Epub 2018 Jul 14.
Regular physical exercise induces cardiac adaptations that can overlap pathological conditions. Controversy still persists about the variability of myocardial deformation in different types and intensity of exercise. The aim of this study was to assess myocardial longitudinal deformation in athletes with different level of exercise. Two groups of young athletes involved in endurance sports characterized by high intensity dynamic component were enrolled. According to the level and the number of exercise training hours/week, two groups were defined: Group 1-high level (national/international and ≥ 20 training-hours/week; N = 60); Group 2-low level (recreational/regional and < 10 training-hours/week; N = 48). A comprehensive transthoracic echocardiogram including evaluation of global longitudinal strain (GLS) assessed by 2D speckle-tracking was performed. Athletes in Group 1 showed more pronounced cardiac remodeling and enhanced diastolic function. No significant differences were evident in left ventricle ejection fraction (LVEF) between groups. Overall, GLS (absolute values) was 18.0 ± 2.5%, but significantly lower in Group 1 compared to Group 2 (17.3 ± 2.6% vs. 18.9 ± 2.1%; p = 0.001). Thirty-three (31%) athletes had GLS below 17%, more frequently in Group 1 (79% vs. 45%; p = 0.001), with higher LV and left atrium volumes, lower E wave and A wave peak velocities and E/e' ratio. In a multivariate analysis to belong to Group 1 was the only independent variable associated with GLS < 17% (OR 6.5; 95% CI 2.4-17.4; p < 0.001). The athletes with a GLS < 17% were all men, more frequently involved in high level exercise, with higher chamber volumes and lower E/e' ratio. Left ventricular global myocardial longitudinal deformation evaluated by GLS was significantly lower in athletes with higher level of exercise. Although GLS in athletes overlap several pathological conditions, these lower values are associated with an enhanced diastolic performance that allows discrimination between physiologic adaptations and pathology.
规律的体育锻炼会引发心脏适应性变化，这些变化可能与病理状况重叠。关于不同类型和强度运动中心肌变形的变异性，争议仍然存在。本研究的目的是评估不同运动水平运动员的心肌纵向变形情况。招募了两组参与以高强度动态成分为特征的耐力运动的年轻运动员。根据运动训练水平和每周训练小时数，将两组进行了定义：第1组——高水平组（国家级/国际级且每周训练时间≥20小时；N = 60）；第2组——低水平组（业余/地区级且每周训练时间<10小时；N = 48）。进行了一次全面的经胸超声心动图检查，包括通过二维斑点追踪评估整体纵向应变（GLS）。第1组运动员表现出更明显的心脏重塑和舒张功能增强。两组之间左心室射血分数（LVEF）无明显差异。总体而言，GLS（绝对值）为18.0±2.5%，但第1组明显低于第2组（17.3±2.6%对18.9±2.1%；p = 0.001）。33名（31%）运动员的GLS低于17%，在第1组中更为常见（79%对45%；p = 0.001），其左心室和左心房容积更大，E波和A波峰值速度以及E/e'比值更低。在多变量分析中，属于第1组是与GLS<17%相关的唯一独立变量（比值比6.5；95%置信区间2.4 - 17.4；p<0.001）。GLS<17%的运动员均为男性，更常参与高水平运动，心室容积更大，E/e'比值更低。通过GLS评估的左心室整体心肌纵向变形在运动水平较高的运动员中明显更低。尽管运动员的GLS与多种病理状况重叠，但这些较低的值与舒张功能增强相关，这有助于区分生理适应性变化和病理状况。
