Abstract：
BACKGROUND: Assessment of the athlete\'s heart is challenging because of a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The potential value of myocardial deformation remains controversial in identifying early cardiomyopathy.
OBJECTIVE: To identify the echocardiographic phenotype of athletes using advanced two-dimensional speckle tracking imaging, and to define predictive factors of subtle left ventricular systolic dysfunction.
METHODS: In total, 191 healthy male athletes who underwent a preparticipation medical evaluation at Nancy University Hospital between 2013 and 2020 were included. Clinical and echocardiographic data were compared with 161 healthy male subjects from the STANISLAS cohort. Borderline global longitudinal strain value was defined as<17.5%.
RESULTS: Athletes demonstrated lower left ventricular ejection fraction (57.9±5.3% vs. 62.6±6.4%; P<0.01) and lower global longitudinal strain (17.5±2.2% vs. 21.1±2.1%; P<0.01). No significant differences were found between athletes with and without a borderline global longitudinal strain value regarding clinical characteristics, structural echocardiographic features and exercise capacity. A borderline global longitudinal strain value was associated with a lower endocardial global longitudinal strain (18.8±1.2% vs. 22.7±1.9%; P=0.02), a lower epicardial global longitudinal strain (14.0±1.1% vs. 16.6±1.2%; P<0.01) and a higher endocardial/epicardial global longitudinal strain ratio (1.36±0.07 vs. 1.32±0.06; P<0.01). No significant difference was found regarding mechanical dispersion (P=0.46).
CONCLUSIONS: Borderline global longitudinal strain value in athletes does not appear to be related to structural remodelling, mechanical dispersion or exercise capacity. The athlete\'s heart is characterized by a specific myocardial deformation pattern with a more pronounced epicardial layer strain impairment.
OBJECTIVE: To identify the echocardiographic phenotype of athletes using advanced two-dimensional speckle tracking imaging, and to define predictive factors of subtle left ventricular systolic dysfunction.
METHODS: In total, 191 healthy male athletes who underwent a preparticipation medical evaluation at Nancy University Hospital between 2013 and 2020 were included. Clinical and echocardiographic data were compared with 161 healthy male subjects from the STANISLAS cohort. Borderline global longitudinal strain value was defined as<17.5%.
RESULTS: Athletes demonstrated lower left ventricular ejection fraction (57.9±5.3% vs. 62.6±6.4%; P<0.01) and lower global longitudinal strain (17.5±2.2% vs. 21.1±2.1%; P<0.01). No significant differences were found between athletes with and without a borderline global longitudinal strain value regarding clinical characteristics, structural echocardiographic features and exercise capacity. A borderline global longitudinal strain value was associated with a lower endocardial global longitudinal strain (18.8±1.2% vs. 22.7±1.9%; P=0.02), a lower epicardial global longitudinal strain (14.0±1.1% vs. 16.6±1.2%; P<0.01) and a higher endocardial/epicardial global longitudinal strain ratio (1.36±0.07 vs. 1.32±0.06; P<0.01). No significant difference was found regarding mechanical dispersion (P=0.46).
CONCLUSIONS: Borderline global longitudinal strain value in athletes does not appear to be related to structural remodelling, mechanical dispersion or exercise capacity. The athlete\'s heart is characterized by a specific myocardial deformation pattern with a more pronounced epicardial layer strain impairment.
摘要：
背景：由于反应性生理适应和病理性重塑之间的表型重叠，对运动员心脏的评估具有挑战性。心肌变形的潜在价值在识别早期心肌病中仍存在争议。
目的：使用高级二维斑点追踪成像技术识别运动员的超声心动图表型，并定义微小左心室收缩功能障碍的预测因素。
方法：总共，纳入了191名健康男性运动员，他们在2013年至2020年期间在南希大学医院接受了参与前医学评估。将临床和超声心动图数据与来自STANISLAS队列的161名健康男性受试者进行比较。边界线整体纵向应变值定义为<17.5%。
结果：运动员表现出更低的左心室射血分数（57.9±5.3％vs.62.6±6.4%；P<0.01）和较低的整体纵向应变（17.5±2.2%vs.21.1±2.1%；P<0.01）。在具有和不具有临床特征的边界全局纵向应变值的运动员之间没有发现显着差异。结构超声心动图特征和运动能力。临界整体纵向应变值与下心内膜整体纵向应变相关(18.8±1.2%vs.22.7±1.9%；P=0.02），心外膜整体纵向应变较低(14.0±1.1%vs.16.6±1.2%；P<0.01）和更高的心内膜/心外膜整体纵向应变比（1.36±0.07vs.1.32±0.06；P<0.01）。在机械分散性方面没有发现显着差异（P=0.46）。
结论：运动员的边界全局纵向应变值似乎与结构重塑无关，机械分散或运动能力。运动员心脏的特征是具有更明显的心外膜应变损害的特定心肌变形模式。
目的：使用高级二维斑点追踪成像技术识别运动员的超声心动图表型，并定义微小左心室收缩功能障碍的预测因素。
方法：总共，纳入了191名健康男性运动员，他们在2013年至2020年期间在南希大学医院接受了参与前医学评估。将临床和超声心动图数据与来自STANISLAS队列的161名健康男性受试者进行比较。边界线整体纵向应变值定义为<17.5%。
结果：运动员表现出更低的左心室射血分数（57.9±5.3％vs.62.6±6.4%；P<0.01）和较低的整体纵向应变（17.5±2.2%vs.21.1±2.1%；P<0.01）。在具有和不具有临床特征的边界全局纵向应变值的运动员之间没有发现显着差异。结构超声心动图特征和运动能力。临界整体纵向应变值与下心内膜整体纵向应变相关(18.8±1.2%vs.22.7±1.9%；P=0.02），心外膜整体纵向应变较低(14.0±1.1%vs.16.6±1.2%；P<0.01）和更高的心内膜/心外膜整体纵向应变比（1.36±0.07vs.1.32±0.06；P<0.01）。在机械分散性方面没有发现显着差异（P=0.46）。
结论：运动员的边界全局纵向应变值似乎与结构重塑无关，机械分散或运动能力。运动员心脏的特征是具有更明显的心外膜应变损害的特定心肌变形模式。
