Myocardial imaging echocardiography in the evaluation of aortic distensibility and ventricular function in strength-trained, endurance-trained and mixed-trained athletes

Purpose. Adaptations to exercise are dependent on the specific type of training performed. Previous studies have shown distinct models of cardiac adaptations to the training in master athletes and different effects of endurance and strength-training on cardiovascular function. We attempted to assess the relationship between aortic function and left ventricular (LV) function parameters in athletes with different forms of training by using the new technologies of tissue Doppler imaging (TDI) and speckle tracking imaging (STI). Methods. We examined 17 male marathon runners (endurance-trained athletes, ETA), 17 power lifting athletes (strength-trained athletes, STA), 17 martial arts athletes (concurrent-trained athletes, MTA), and 17 sedentary untrained healthy men (controls, CTR). Comprehensive echocardiography was performed for the assessment of LV systolic/diastolic function. LV longitudinal and radial strain and LV torsion (LVT) were determined using STI echocardiography. Aortic distensibility (AoD) and aortic stiffness index were calculated using accepted formulae. Maximum velocity of the first and second systolic wall expansion peaks, acceleration time, maximum velocity of early and late diastolic retraction velocity peaks of the ascending aorta and wall peak systolic strain (AoS, %) were determined (EchoPAC, version 9.0, GE-Ultrasound). Results. ETA experienced LV eccentric hypertrophy, characterized by increased LV end-diastolic volume (93.7 ± 8.2 ml/m2 vs 81.4 ± 8.5 ml/m2, p < 0.001) and LV mass (119.3 ± 12.1 g/m2 vs 102.5 ± 11.2 g/m2, p = 0.001). There was a significant increase in peak systolic apical rotation (12.9 ± 3.4° vs 8.6 ± 4.1°, p = 0.002) but no change in basal rotation. This translated into a highly significant increase in peak systolic LVT after endurance exercise training (18.3 ± 3.7° vs 14.2 ± 4.8°, p = 0.002). AoS (ETA: 7.7±1.9%, STA: 19.8±3.7%, CTR: 15.4±2.2%, p< .001) and AoD (ETA: 43±11 m2/N, STA: 88±15 m2/N, CTR: 71±13 m2/N, p< .005) were significantly decreased in ETA and significantly increased in STA compared with CTR. MTA had significantly increased LV end-diastolic volume and peak systolic LVT and significantly decreased aortic strain and distensibility with less significance compared to ETA. There were good correlations between LV function and aortic stiffness values. Multivariate analysis showed aortic distensibility and strain to be independently related to LV mass index and diastolic function. Conclusions. In strength-trained, endurance-trained and concurrent-trained athletes ventricular-vascular response underlies different adaptations of TDI-STI LV-aortic indexes.