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Supernormal Diastolic Function and Role of Left Atrial Myocardial Deformation Analysis by 2D Speckle Tracking Echocardiography in Elite Soccer Players


Address for correspondence and reprint requests: Flavio D’Ascenzi, M.D., Department of Cardiovascular Diseases, University of Siena, Viale M. Bracci, Siena, Italy. Fax: 00390577585377; E-mail:


Purpose: Top-level training is associated with morphological and functional changes in the heart. Left atrial (LA) enlargement can be regarded as a physiologic adaptation to exercise conditioning. Athletes show an improvement in myocardial diastolic properties and supernormal left ventricular (LV) diastolic function. The aims of the study were to assess diastolic function by pulsed Doppler tissue imaging (DTI) and to analyze the role of LA in athletes by speckle tracking echocardiography (STE). Methods: Twenty-three male elite soccer players underwent a complete echocardiographic analysis. Twenty-six age-matched healthy sedentary men were used as controls. Measured variables included LA indexed volumes, DTI of the LV, peak atrial longitudinal strain, and peak atrial contraction strain (PACS). Results: LA areas and indexed volumes were significantly higher in athletes (P < 0.001). Athletes had a higher peak E velocity (P < 0.001), a lower A peak (P < 0.01), and a higher peak E/A ratio (P < 0.0001); a higher Em peak (P < 0.001), a lower Am peak (P < 0.01), and a higher Em/Am ratio (P < 0.0001). Global PACS was lower in athletes compared with controls (P < 0.0001) and strongly correlated with mitral Am (r = 0.55; P < 0.0001), mitral Em (r =−0.41; P < 0.001), heart rate (r =−0.38; P < 0.01), and LA area (r = 0.18; P < 0.05). Conclusions: Athletes showed a shift in the pattern of ventricular filling period toward early diastole as seen through DTI analysis of the diastolic properties of LV and STE analysis of LA function. DTI is a useful tool to analyze the improved myocardial diastolic properties of athletes and STE may elucidate the role of LA in the context of athlete's heart remodeling. (Echocardiography 2011;28:320-326)