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Myocardial stiffness reduced in elite athletes

Heart 2008; 94: 1354-1325

Elite athletes tend to have reduced myocardial stiffness even in the presence of left ventricular hypertrophy (LVH), Irish researchers have shown.

Gerard King and colleagues at St James's Hospital in Dublin, Ireland, used a new Doppler tissue index to assess 36 international rowers, who train intensively, and 30 sedentary controls matched for age and gender.

All participants underwent echocardiographic examination with Doppler tissue imaging. Myocardial stiffness was derived from three parameters: the transmitral Doppler peak E velocity (E), the early diastolic myocardial velocity (Ea), and the left ventricular end-diastolic diameter in diastole (LVEDD).

The study found that myocardial stiffness, defined as (E/Ea)/LVEDD, was significantly lower in rowers than in sedentary controls (1.17 vs 1.48, p=0.016).

This difference persisted after adjustment for confounding variables including body surface area and heart rate, and was driven by a significantly greater LVEDD in athletes (5.6 vs 4.8 cm, p<0.001).

Interestingly, LVEDD and myocardial stiffness in athletes were comparable irrespective of the presence of LVH, leading King et al to remark that the "key distinguishing feature of intense training is a reduction of myocardial stiffness despite the development of increased wall thickness."

Writing in the journal Heart, the study authors conclude: "An understanding of this physiological change may enable more accurate and earlier diagnosis of an abnormal response to high-intensity training."

The authors of an accompanying editorial commented that the new stiffness index is "a potential differentiator of the athletic heart," but note: "Whether it will offer additional value to independent echo assessment of LV structure and standard tissue Doppler evaluation of LV diastolic function in the clinical practice of excluding underlying cardiomyopathy in athletes is unclear."

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