The effect of exercise training on left ventricular function in young elite athletes

<p>Abstract</p> <p>Background</p> <p>Regular training, in particular endurance exercise, induces structural myocardial adaptation, so-called "athlete's heart". In addition to the 2D standard echo parameters, assessment of myocardial function is currently possible by deformation parameters (strain, rotation and twist). Aim of study is to assess the role of rotation and twist parameters for better characterize the heart performance in trained elite young athletes from different kind of sports. Eventually, verify early on any possible impact due to the regular sport activity not revealed by the standard parameters.</p> <p>Methods</p> <p>50 young athletes (16 cyclists, 17 soccer players, 17 basket players) regularly trained at least three times a week for at least 9 months a year and 10 young controls (mean age 18.5 ± 0.5 years) were evaluated either by to 2D echocardiography or by a Speckle Tracking (ST) multi-layer approach to calculate Left Ventricle (LV) endocardial and epicardial rotation, twist, circumferential strain (CS) and longitudinal strain (LS). Data were compared by ANOVA test.</p> <p>Results</p> <p>All the found values were within the normal range. Left Ventricle Diastolic Diameter (LVDD 51.7 ± 2.6 mm), Cardiac Mass index (CMi 114.5 ± 18.5 g/m²), epi-CS, epi-LS, epicardial apex rotation and the Endo/Epi twist were significantly higher only in cyclists. In all the groups, a physiological difference of the Endo/Epi basal circumferential strain and twist values have been found. A weak but not significant relationship between the Endo and twist values and LVDD (r²= 0.44, p = .005) and CMi was also reported in cyclists.</p> <p>Conclusions</p> <p>Progressive increase of apical LV twist may represent an important component of myocardial remodelling. This aspect is particularly evident in the young cyclists group where the CMi and the LVDD are higher. ST multilayer approach completes the LV performance evaluation in young trained athletes showing values similar to adults.</p

Cardiovascular Outcomes in Renal Transplant Recipients: Feasibility and Clinical Role of 2D Speckle Tracking to Assess Myocardial Function

however, few data are available about the role of 2D echocardiography (2DE) and 2D speckle tracking echocardiography (2DSTE) on renal transplant recipients (RTR). From a large cohort of RTR submitted to a supervised exercise as the prescription program, 10 subjects who were regularly trained were studied for sixth months. They underwent periodically an echo evaluation (ESAOTE MyLab 50), cardiopulmonary test (CPT) and strength test for the lower and upper limbs. The LV function study was completed with the speckle tracking longitudinal strain (Lo Strain) measure calculated by dedicated software (XStrain–Esaote) at the end of the protocol. All of the cardiovascular parameters were normal: the ejection fraction (EF) increased significantly (from 62.7 ± 4 to 67.2 ± 2.3 with p &l

2D longitudinal LV speckle tracking strain pattern in breast cancer survivors: sports activity vs exercise as prescription model

Prevention strategies are important to optimize and to manage heart care in breast cancer survivors. Regular physical activity at moderate intensity is normally proposed to maintain myocardial performance; however, no data is available about the different impact of different levels of physical exercise. 2D speckle tracking echocardiography (2DSTE) is an accepted method for early detection of myocardial dysfunction. The study aims to monitor the cardiac performances in breast cancer survivors by 2DSTE analysis to manage sports activity vs physical activity. Two groups of previous breast cancer survivors (33 BCS) trained at moderate intensity and 55 athletes practicing dragon boat (DBA) sport were enrolled. They were matched with two healthy subjects groups: 23 competitive female athletes practicing different sports and 20 healthy women trained with exercise as prescription model. All women were studied by a complete echo examination including LV global longitudinal strain (GLS) assessment (XStrain-Esaote). EF and GS are only significantly higher in healthy subjects (-25.4 \ub1 2.1). Nevertheless, GLS values are within the normal range for all groups. Particularly, GS does not show any significant differences among subjects (-19.93 \ub1 4) practicing exercise as prescription when compared to the DBA competitive trained group. 2DSTE method is an appropriate method to supervise the intensity of exercise in breast cancer patients. Particularly, GLS can optimize and improve cancer therapy supporting and creating efficiencies within the health system confirming the role of the exercise prescription therapy in maintaining normal heart function

Cardiovascular Outcomes in Renal Transplant Recipients: Feasibility and Clinical Role of 2D Speckle Tracking to Assess Myocardial Function

however, few data are available about the role of 2D echocardiography (2DE) and 2D speckle tracking echocardiography (2DSTE) on renal transplant recipients (RTR). From a large cohort of RTR submitted to a supervised exercise as the prescription program, 10 subjects who were regularly trained were studied for sixth months. They underwent periodically an echo evaluation (ESAOTE MyLab 50), cardiopulmonary test (CPT) and strength test for the lower and upper limbs. The LV function study was completed with the speckle tracking longitudinal strain (Lo Strain) measure calculated by dedicated software (XStrain–Esaote) at the end of the protocol. All of the cardiovascular parameters were normal: the ejection fraction (EF) increased significantly (from 62.7 ± 4 to 67.2 ± 2.3 with p &l

Two-dimensional speckle tracking echocardiography: standardization efforts based on synthetic ultrasound data

AIMS: Speckle tracking echocardiography has already demonstrated its clinical potential. However, its use in routine practice is jeopardized by recent reports on high inter-vendor variability of the measurements. As such, the European Association of CardioVascular Imaging (EACVI) and the American Society of Echocardiography (ASE) set up a standardization task force, which was joined by all manufacturers of echocardiographic equipment as well as by companies offering software solutions only, with the ambition to tackle this problem by standardization and quality assurance (QA). METHODS AND RESULTS: In this study, a first step towards QA of all commercially available tracking solutions based on computer-generated ultrasound images is presented. The accuracy of the products was acceptable with relative errors below 10% and intra-vendor reproducibility within 5%. CONCLUSION: Whether these results can be extrapolated to the clinical setting is the topic of an ongoing study of the EACVI/ASE/Industry Task Force to standardize deformation imaging. This study was an important first step in the development of generally accepted tools for QA of speckle tracking echocardiography.status: publishe

Two-dimensional speckle tracking echocardiography: Standardization efforts based on synthetic ultrasound data

AIMS: Speckle tracking echocardiography has already demonstrated its clinical potential. However, its use in routine practice is jeopardized by recent reports on high inter-vendor variability of the measurements. As such, the European Association of CardioVascular Imaging (EACVI) and the American Society of Echocardiography (ASE) set up a standardization task force, which was joined by all manufacturers of echocardiographic equipment as well as by companies offering software solutions only, with the ambition to tackle this problem by standardization and quality assurance (QA). METHODS AND RESULTS: In this study, a first step towards QA of all commercially available tracking solutions based on computer-generated ultrasound images is presented. The accuracy of the products was acceptable with relative errors below 10% and intra-vendor reproducibility within 5%. CONCLUSION: Whether these results can be extrapolated to the clinical setting is the topic of an ongoing study of the EACVI/ASE/Industry Task Force to standardize deformation imaging. This study was an important first step in the development of generally accepted tools for QA of speckle tracking echocardiography

Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging

Recognizing the critical need for standardization in strain imaging, in 2010, the European Association of Echocardiography (now the European Association of Cardiovascular Imaging, EACVI) and the American Society of Echocardiography (ASE) invited technical representatives from all interested vendors to participate in a concerted effort to reduce intervendor variability of strain measurement. As an initial product of the work of the EACVI/ASE/Industry initiative to standardize deformation imaging, we prepared this technical document which is intended to provide definitions, names, abbreviations, formulas, and procedures for calculation of physical quantities derived from speckle tracking echocardiography and thus create a common standard

Variability and Reproducibility of Segmental Longitudinal Strain Measurement: A Report From the EACVI-ASE Strain Standardization Task Force

OBJECTIVES: In this study, we compared left ventricular (LV) segmental strain measurements obtained with different ultrasound machines and post-processing software packages. BACKGROUND: Global longitudinal strain (GLS) has proven to be a reproducible and valuable tool in clinical practice. Data about the reproducibility and intervendor differences of segmental strain measurements, however, are missing. METHODS: We included 63 volunteers with cardiac magnetic resonance-proven infarct scar with segmental LV function ranging from normal to severely impaired. Each subject was examined within 2 h by a single expert sonographer with machines from multiple vendors. All 3 apical views were acquired twice to determine the test-retest and the intervendor variability. Segmental longitudinal peak systolic, end-systolic, and post-systolic strain were measured using 7 vendor-specific systems (Hitachi, Tokyo, Japan; Esaote, Florence, Italy; GE Vingmed Ultrasound, Horten, Norway; Philips, Andover, Massachusetts; Samsung, Seoul, South Korea; Siemens, Mountain View, California; and Toshiba, Otawara, Japan) and 2 independent software packages (Epsilon, Ann Arbor, Michigan; and TOMTEC, Unterschleissheim, Germany) and compared among vendors. RESULTS: Image quality and tracking feasibility differed among vendors (analysis of variance, p < 0.05). The absolute test-retest difference ranged from 2.5% to 4.9% for peak systolic, 2.6% to 5.0% for end-systolic, and 2.5% to 5.0% for post-systolic strain. The average segmental strain values varied significantly between vendors (up to 4.5%). Segmental strain parameters from each vendor correlated well with the mean of all vendors (r2 range 0.58 to 0.81) but showed very different ranges of values. Bias and limits of agreement were up to -4.6 \ub1 7.5%. CONCLUSIONS: In contrast to GLS, LV segmental longitudinal strain measurements have a higher variability on top of the known intervendor bias. The fidelity of different software to follow segmental function varies considerably. We conclude that single segmental strain values should be used with caution in the clinic. Segmental strain pattern analysis might be a more robust alternative

Intervendor Differences in the Accuracy of Detecting Regional Functional Abnormalities: A Report From the EACVI-ASE Strain Standardization Task Force

OBJECTIVES: The purpose of this study was to compare the accuracy of vendor-specific and independent strain analysis tools to detect regional myocardial function abnormality in a clinical setting. BACKGROUND:Speckle tracking echocardiography has been considered a promising tool for the quantitative assessment of regional myocardial function. However, the potential differences among speckle tracking software with regard to their accuracy in identifying regional abnormality has not been studied extensively. METHODS: Sixty-three subjects (5 healthy volunteers and 58 patients) were examined with 7 different ultrasound machines during 5 days. All patients had experienced a previous myocardial infarction, which was characterized by cardiac magnetic resonance with late gadolinium enhancement. Segmental peak systolic (PS), end-systolic (ES) and post-systolic strain (PSS) measurements were obtained with 6 vendor-specific software tools and 2 independent strain analysis tools. Strain parameters were compared between fully scarred and scar-free segments. Receiver-operating characteristic curves testing the ability of strain parameters and derived indexes to discriminate between these segments were compared among vendors. RESULTS: The average strain values calculated for normal segments ranged from -15.1% to -20.7% for PS, -14.9% to -20.6% for ES, and -16.1% to -21.4% for PSS. Significantly lower values of strain (p < 0.05) were found in segments with transmural scar by all vendors, with values ranging from -7.4% to -11.1% for PS, -7.7% to -10.8% for ES, and -10.5% to -14.3% for PSS. Accuracy in identifying transmural scar ranged from acceptable to excellent (area under the curve 0.74 to 0.83 for PS and ES and 0.70 to 0.78 for PSS). Significant differences were found among vendors (p < 0.05). All vendors had a significantly lower accuracy to detect scars in the basal segments compared with scars in the apex (p < 0.05). CONCLUSIONS: The accuracy of identifying regional abnormality differs significantly among vendors