Left Ventricular Untwisting in Athlete’s Heart: Key Role in Early Diastolic Filling?

A. Kovács; A. Apor; A. Nagy; H. Vágó; A. Tóth; A. I. Nagy; T. Kováts; B. Sax; G. Széplaki; D. Becker; B. Merkely

doi:10.1055/s-0033-1349076

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2014; 35(03): 259-264
DOI: 10.1055/s-0033-1349076

Clinical Sciences

Left Ventricular Untwisting in Athlete’s Heart: Key Role in Early Diastolic Filling?

A. Kovács

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

A. Apor

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

A. Nagy

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

H. Vágó

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

A. Tóth

²Heart and Vascular Center, Diagnostic Radiology Unit, Semmelweis University, Budapest, Hungary

,

A. I. Nagy

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

T. Kováts

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

B. Sax

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

G. Széplaki

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

D. Becker

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

,

B. Merkely

¹Laboratory of Echocardiography, Heart and Vascular Center, FIFA Medical Centre of Excellence, Budapest, Hungary

› Author Affiliations

Abstract

Untwisting contributes to left ventricular filling through suction generation. We sought to investigate diastolic function and untwisting dynamics in different forms of left ventricular hypertrophy: in athlete’s heart and hypertrophic cardiomyopathy. Elite athletes in kayaking, canoeing and rowing (n=28), patients with hypertrophic cardiomyopathy (HCM, n=15) and healthy sedentary volunteers (n=13) were compared. Left ventricular volumes, wall thickness-to-volume ratio were assessed by cardiac MRI. Following conventional and tissue Doppler measurements, untwist and untwist rate were determined by speckle tracking echocardiography. Wall thickness-to-volume ratio describing remodelling was significantly higher in HCM, but similar in athletes and controls (athlete vs. HCM vs. control: 0.107±0.019 vs. 0.271±0.091 vs. 0.104±0.012 mm×m²/ml, mean±SD, p<0.001). Mitral lateral annulus e’ velocity referred to diastolic dysfunction in HCM (15.3±3.6 vs. 7.9±3.3 vs. 15.0±3.0 cm/s, p<0.01). At time point of mitral valve opening, untwist and untwist rate were significantly different: the highest values were measured in athletes, while the lowest were found in HCM (untwist: 51.3±19.1 vs. 11.6±10.4 vs. 35.9±16.3%; untwist rate: −32.5±13.0 vs. −10.6±10.8 vs. −23.0±7.7°/s, p<0.05). Untwisting correlated with E/A, e’ and E/e’. Athlete’s heart is characterized by increased untwist and untwist rate, which can aid diastolic function. Evaluation of untwisting dynamics may help to distinguish pathological hypertrophy.

Key words

echocardiography - speckle tracking - untwist - MRI - athlete's heart

Full Text

References

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