Left ventricular function in professional football players evaluated by tissue Doppler imaging and strain imaging

Background Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler Imaging(TDI) and Strain Myocardial Imaging(SI) are new tools in the evaluation systolic and diastolic myocardial function. We sought to compare TDI and SI findings in professional football players and age adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. Methods Transthoracic echocardiography, M-mode, 2-D measurements, Doppler derived mitral-tricuspid annular velocities, reconstructed spectral pulsed wave tissue Doppler velocities, strain and strain rate imaging of seven different myocardial regions were obtained from 24 professional football players and age, sex and weight adjusted 20 controls. Results Age, body surface area, blood pressure and heart rate were comparable between 2 groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal TDI peak early diastolic(e) velocity(0.22 +/- 0.04 vs. 0.19 +/- 0.04 m/s, P < 0.05), lateral TDI peak e velocity (0.19 +/- 0.03 vs. 0.16 +/- 0.02 m/s, P < 0.05) and lateral TDI e/a ratio (1.96 +/- 0.41 and 1.66 +/- 0.23, P < 0.05). In SI analysis mid septal walls (1.71 +/- 0.23 in athletes and 1.49 +/- 0.25 in controls, P < 0.05) and mid lateral walls (1.55 +/- 0.28 and 1.34 +/- 0.25 respectively, P < 0.05) peak systolic strain rate values differences were found to be increased in athletes. Conclusion Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function which can be detected by TDI. Strain rate imaging may be a new tool to define subtle change in systolic left ventricular function in "athletes heart" which cannot be determined in standard echocardiographic parameters.