Assessment of Left Ventricular Myocardial Function in Wrestlers: A Focus on Speckle Tracking Echocardiography

Yıl 2022, Cilt: 11 Sayı: 2, 248 - 254, 14.07.2022

Onur Argan , Serdar Bozyel , Kadriye Akay , Eyüp Avcı , Tuncay Kırış

https://doi.org/10.53424/balikesirsbd.1028121

Öz

Objective: Athlete’s heart is related with physiological adaptation as a result of recurrent cardiac overloading. However, these exercise-induced changes can be confused with pathological conditions and it can be difficult to differentiate with traditional echocardiographic parameters. Recently, speckle tracking echocardiography (STE) has provided new perspectives in differentiating athlete's heart from pathological heart disease. In specific sports such as wrestling, there is not enough data on this method. The aim of study was to evaluate myocardial function of wrestlers using 2D-speckle tracking echocardiography imaging. Material and Methods: 23 healthy individuals and 20 wrestlers were included in the study. Ventricular strain values were evaluated by apical 2,3 and 4 chamber imaging. Global longitudinal strain (GLS) was calculated by averaging three apical views. Results: Left ventricular (LV) longitudinal two, three and four chamber strain and LV GLS were slightly lower but not statistically significant in the wrestlers [-17.9(16.4-19.5)] compared with control group [-19.1(16.2-20.7)], (p=0.084, p=0.603, p=0.119, p=0.228, respectively]. There was not any difference regarding the left ventricle ejection fraction (p=0.455). E wave, A wave, e’wave, E/A and E/e’ ratio were similar between groups (p=0.210, p=0.826, p=0.505, p=0.468, p=0.451, respectively). GLS showed significant correlation with e’wave (r=0.561, p<0.001). Conclusion:LV myocardial deformation evaluated by GLS was slightly lower but similar in the wrestlers compared to the healty individuals. It may be useful to clinicians in evaluating athelet’s heart in addition to conventional echocardiographic parameters.

Anahtar Kelimeler

Sport Medicine, Transthoracic Echocardiography, Wrestling

Teşekkür

The authors would like to thanks to Wrestling Referee Okan Durak for his contribution.

Güreşçilerde Sol Ventriküler Miyokard Fonksiyonunun Değerlendirilmesi: Benek İzleme Ekokardiyografisi Odaklı Görüntüleme

Öz

Amaç: Atlet kalbi, egzersiz kaynaklı kalbin aşırı yüklenmesiyle oluşan fizyolojik bir adaptasyondur. Ancak egzersize bağlı değişiklikler patolojik durumlarla karışabilmekte ve geleneksel ekokardiyografik parametreler ile ayrım zorlaşabilmektedir. Benek takibi ekokardiyografisi atlet kalbi ile kalp hastalıklarını ayırmada yeni bakış açıları sağlamıştır. Güreşçilik gibi spesifik spor dallarında ise bu yöntemle ilgili yeterince veri yoktur. Bu çalışmanın amacı, benek takibi ekokardiyografisi kullanarak güreşçilerin miyokardiyal fonksiyonunu değerlendirmektir. Gereç ve Yöntem: Çalışmaya 20 güreşçi ve 23 sağlıklı birey dahil edildi. Ventriküler gerilme değerleri apikal iki, üç ve dört boşluk görüntüleri ile değerlendirildi. Global longitudinal gerilme (GLS) 3 görünümün ortalaması alınarak hesaplandı. Bulgular: Güreşçilerde sol ventrikül longitudinal 2, 3 ve 4 boşluk gerilme ve sol ventrikül GLS değerleri [güreşçilerde -17.9 (16.4-19.5), kontrol grubunda -19.1(16.2-20.7)] hafif düşük olmakla birlikte istatistiki olarak anlamlı fark saptanmadı (p=0.084,p=0.603, p=0.119,p=0.228,sırasıyla). Sol ventrikül ejeksiyon fraksiyonları arasında fark yoktu (p=0.455). E, A, e’ dalgası, E/A ve E/e’ oranı gruplar arasında benzerdi (p=0.210,p=0.826,p=0.505,p=0.468,p=0.451,sırasıyla). GLS, e’ ile anlamlı olarak koreleydi (r=0.561,p<0.001). Sonuç: GLS ile değerlendirilen sol ventrikül miyokard deformasyonu güreşçilerde sağlıklı bireylere göre daha düşük olmakla birlikte istatistiki olarak benzer saptandı. GLS, konvansiyonel ekokardiyografik parametrelere ek olarak sporcu kalbinin değerlendirilmesinde klinisyenlere fayda sağlayabilir.

Anahtar Kelimeler

Spor Tıbbı, Transtorasik Ekokardiyografi, Güreş

Kaynakça

• Chaabene H, Negra Y, Bouguezzi R, Mkaouer B, Franchini E, Julio U et al. Physical and physiological attributes of wrestlers: an update. Journal of strength and conditioning research. 2017 May;31(5):1411-1442. doi: 10.1519/JSC.0000000000001738. Review.
• Forsythe L, George K, Oxborough D. Speckle tracking echocardiography for the assessment of the athlete's heart: is it ready for daily practice? Current treatment options in cardiovascular medicine. 2018 Aug 27;20(10):83. doi: 10.1007/s11936-018-0677-0. Review.
• Beaumont A, Grace F, Richards J, Hough J, Oxborough D, Sculthorpe N. Left ventricular speckle tracking-derived cardiac strain and cardiac twist mechanics in athletes: a systematic review and meta-analysis of controlled studies. Sports medicine. 2017 Jun;47(6):1145-1170. doi: 10.1007/s40279-016-0644-4. Review.
• Pluim, B. M., Zwinderman, A. H., van der Laarse, A., & van der Wall, E. E. (2000). The athlete's heart. a meta-analysis of cardiac structure and function. Circulation, 101(3), 336–344. https://doi.org/10.1161/01.cir.101.3.336
• Scott, J. M., & Warburton, D. E. (2008). Mechanisms underpinning exercise-induced changes in left ventricular function. Medicine and science in sports and exercise, 40(8), 1400–1407. https://doi.org/10.1249/MSS.0b013e318172cf10
• Scharhag, J., Schneider, G., Urhausen, A., Rochette, V., Kramann, B., & Kindermann, W. (2002). Athlete's heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. Journal of the American College of Cardiology, 40(10), 1856–1863. https://doi.org/10.1016/s0735-1097(02)02478-6
• Scharf, M., Brem, M. H., Wilhelm, M., Schoepf, U. J., Uder, M., & Lell, M. M. (2010). Cardiac magnetic resonance assessment of left and right ventricular morphologic and functional adaptations in professional soccer players. American heart journal, 159(5), 911–918. https://doi.org/10.1016/j.ahj.2010.02.027
• Shah, A. M., & Solomon, S. D. (2012). Myocardial deformation imaging: current status and future directions. Circulation, 125(2), e244–e248. https://doi.org/10.1161/CIRCULATIONAHA.111.086348
• Butz, T., van Buuren, F., Mellwig, K. P., Langer, C., Plehn, G., Meissner, A., Trappe, H. J., Horstkotte, D., & Faber, L. (2011). Two-dimensional strain analysis of the global and regional myocardial function for the differentiation of pathologic and physiologic left ventricular hypertrophy: a study in athletes and in patients with hypertrophic cardiomyopathy. The international journal of cardiovascular imaging, 27(1), 91–100. https://doi.org/10.1007/s10554-010-9665-5
• Saghir, M., Areces, M., & Makan, M. (2007). Strain rate imaging differentiates hypertensive cardiac hypertrophy from physiologic cardiac hypertrophy (athlete's heart). Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 20(2), 151–157. https://doi.org/10.1016/j.echo.2006.08.006
• Perk, G., Tunick, P. A., & Kronzon, I. (2007). Non-doppler two-dimensional strain imaging by echocardiography--from technical considerations to clinical applications. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 20(3), 234–243. https://doi.org/10.1016/j.echo.2006.08.023
• Smiseth, O. A., Torp, H., Opdahl, A., Haugaa, K. H., & Urheim, S. (2016). Myocardial strain imaging: how useful is it in clinical decision making?. European heart journal, 37(15), 1196–1207. https://doi.org/10.1093/eurheartj/ehv529
• Tower-Rader, A., Mohananey, D., To, A., Lever, H. M., Popovic, Z. B., & Desai, M. Y. (2019). Prognostic value of global longitudinal strain in hypertrophic cardiomyopathy: a systematic review of existing literature. JACC. Cardiovascular imaging, 12(10), 1930–1942.
• Zuo, H. J., Yang, X. T., Liu, Q. G., Zhang, Y., Zeng, H. S., Yan, J. T., Wang, D. W., & Wang, H. (2018). Global longitudinal strain at rest for detection of coronary artery disease in patients without diabetes mellitus. Current medical science, 38(3), 413–421. https://doi.org/10.1007/s11596-018-1894-1
• Kaufmann, D., Szwoch, M., Kwiatkowska, J., Raczak, G., & Daniłowicz-Szymanowicz, L. (2019). Global longitudinal strain can predict heart failure exacerbation in stable outpatients with ischemic left ventricular systolic dysfunction. Public Library of Science one, 14(12), e0225829. https://doi.org/10.1371/journal.pone.0225829
• Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, et al. European association of preventive cardiology (EAPC) and european association of cardiovascular imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart. European heart journal, 39(21), 1949–1969. https://doi.org/10.1093/eurheartj/ehx532
• Lang RM, Badano LP, Victor Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European heart journal. Cardiovascular Imaging, 16(3), 233–270. https://doi.org/10.1093/ehjci/jev014
• Lang RM, Bierig M, Devereux RB, et al: Recommendations for chamber quantification. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 7(2), 79–108. https://doi.org/10.1016/j.euje.2005.12.014
• De Luca, A., Stefani, L., Pedrizzetti, G., Pedri, S., & Galanti, G. (2011). The effect of exercise training on left ventricular function in young elite athletes. Cardiovascular ultrasound, 9(27). https://doi.org/10.1186/1476-7120-9-27
• MacDougall, J. D., Tuxen, D., Sale, D. G., Moroz, J. R., & Sutton, J. R. (1985). Arterial blood pressure response to heavy resistance exercise. Journal of applied physiology (Bethesda, Md. : 1985), 58(3), 785–790.
• Fagard R. (2003). Athlete's heart. Heart (British Cardiac Society), 89(12), 1455–1461. https://doi.org/10.1136/heart.89.12.1455
• Marwick T. H. (2006). Measurement of strain and strain rate by echocardiography: ready for prime time?. Journal of the American College of Cardiology, 47(7), 1313–1327. https://doi.org/10.1016/j.jacc.2005.11.063.
• Finocchiaro G, Dhutia H, D’Silva A, Malhotra A, Sheikh N, Narain R et al (2018) Role of doppler diastolic parameters in differentiating physiological left ventricular hypertrophy from hypertrophic cardiomyopathy. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 31(5), 606–613.e1.
• Dores, H., Mendes, L., Dinis, P., Cardim, N., Monge, J. C., & Santos, J. F. (2018). Myocardial deformation and volume of exercise: a new overlap between pathology and athlete's heart?. The international journal of cardiovascular imaging, 34(12), 1869–1875. https://doi.org/10.1007/s10554-018-1412-3
• Baggish, A. L., Yared, K., Wang, F., Weiner, R. B., Hutter, A. M., Jr, Picard, M. H., & Wood, M. J. (2008). The impact of endurance exercise training on left ventricular systolic mechanics. American journal of physiology. Heart and circulatory physiology, 295(3), H1109–H1116. https://doi.org/10.1152/ajpheart.00395.2008
• Kovacs A, Apor A, Nagy A, et al. Left ventricular untwisting in athlete’s heart: key role in early diastolic filling? International journal of sports medicine, 35(3), 259–264. https://doi.org/10.1055/s-0033-1349076
• Cappelli F, Toncelli L, Cappelli B, et al. Adaptative or maladaptative hypertrophy, different spatial distribution of myocardial contraction. Clinical physiology and functional imaging, 30(1), 6–12. https://doi.org/10.1111/j.1475-097X.2009.00896.x
• Zocalo Y, Guevara E, Bia D, et al. A reduction in the magnitude and velocity of left ventricular torsion may be associated with increased left ventricular efficiency: evaluation by speckletracking echocardiography. Revista espanola de cardiologia, 61(7), 705–713.
• Lee LS, Mariani JA, Sasson Z, et al. Exercise with a twist: left ventricular twist and recoil in healthy young and middle-aged men, and middle-aged endurance-trained men. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 25(9), 986–993. https://doi.org/10.1016/j.echo.2012.05.018
• Maufrais C, Schuster I, Doucende G, et al. Endurance training minimizes age-related changes of left ventricular twist-untwist mechanics. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 27(11), 1208–1215.
• Caselli, S., Montesanti, D., Autore, C., Di Paolo, F. M., Pisicchio, C., Squeo, M. R., Musumeci, B., Spataro, A., Pandian, N. G., & Pelliccia, A. (2015). Patterns of left ventricular longitudinal strain and strain rate in Olympic athletes. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 28(2), 245–253. https://doi.org/10.1016/j.echo.2014.10.010
• Santoro A, Alvino F, Antonelli G, Caputo M, Padeletti M, Lisi M et al (2014) Endurance and strength athlete’s heart: analysis of myocardial deformation by speckle tracking echocardiography. Journal of cardiovascular ultrasound, 22(4), 196–204. https://doi.org/10.4250/jcu.2014.22.4.196
• Simsek Z, Hakan Tas M, Degirmenci H, et al. Speckle tracking echocardiographic analysis of left ventricular systolic and diastolic functions of young elite athletes with eccentric and concentric type of cardiac remodeling. Echocardiography (Mount Kisco, N.Y.), 30(10), 1202–1208. https://doi.org/10.1111/echo.12263.