Left ventricular performance and ultrasonic myocardial quantitative reflectivity in endurance senior athletes: an echocardiographic study

Young elite athletes often show left ventricular hypertrophy, but normal values of quantitatively evaluated myocardial wall reflectivity. The aim of this study is to assess the acoustic pattern of ventricular wall reflectivity, as well as of systolic and diastolic function, in older endurance runners with increased left ventricular mass. For this purpose, 12 elite, senior isotonic athletes in full training and 11 normal, age-matched controls with sedentary life styles were studied. The following parameters were measured with a commercially available 2D echo-Doppler machine: end-diastolic diameter, diastolic septum thickness, left ventricular mass index, ejection fraction (by Teicholtz rule); peak E, peak A, E/A ratio, acceleration and deceleration time of mitral inflow velocity and isovolumic relaxation time. On-line radio frequency analysis was also performed to obtain quantitative operator-independent measurements of the integrated backscatter signal of the ventricular septum and the posterior wall. The integrated values of the radiofrequency signals were normalized for the pericardial interface and expressed in percent (% 2D-1B). In spite of the greater left ventricular mass in athletes versus normal controls (319±81 vs 225±63 g. m−2, P <0.0005), there were no significant intergroup differences as regards end-diastolic diameter (50.7±5.1 vs 48.1±5.2 mm, P = ns), ejection fraction (75.5±9.3 vs 71.8±9.1%, P = ns), and 2D-1B of septum (22.2±6.9 vs 22.4±7.0, P = ns) and posterior wall (12.5 ±5.6 vs 13.1 ±2.8, P=ns). Endurance athletes when compared with age-matched controls show an increase in left ventricular mass but no significant impairment of systolic and diastolic function detectable by 2D-echo and Doppler indexes. Furthermore, in the athlete group, the quantitatively assessed ultrasonic backscatter of myocardial walls (septum and posterior wall) was found to be comparable to controls in spite of a marked increase in wall thickness suggesting that no significant pathological structural changes occur in the older athletes' heart.