Abstract
Purpose of reviewTo describe the use of speckle tracking echocardiography (STE) in the biventricular assessment of athletes’ heart (AH). Can STE aid differential diagnosis during pre-participation cardiac screening (PCS) of athletes?Recent findingsData from recent patient, population and athlete studies suggest potential discriminatory value of STE, alongside standard echocardiographic measurements, in the early detection of clinically relevant systolic dysfunction. STE can also contribute to subsequent prognosis and risk stratification.SummaryDespite some heterogeneity in STE data in athletes, left ventricular global longitudinal strain (GLS) and right ventricular longitudinal strain (RV ɛ) indices can add to differential diagnostic protocols in PCS. STE should be used in addition to standard echocardiographic tools and be conducted by an experienced operator with significant knowledge of the AH. Other indices, including left ventricular circumferential strain and twist, may provide insight, but further research in clinical and athletic populations is warranted. This review also raises the potential role for STE measures performed during exercise as well as in serial follow-up as a method to improve diagnostic yield.
Highlights
Echocardiography has advanced our knowledge and understanding of the structural and functional adaptation that occurs in the athletes’ heart (AH) in response to chronic training [1–4]
Summary Despite some heterogeneity in speckle tracking echocardiography (STE) data in athletes, left ventricular global longitudinal strain (GLS) and right ventricular longitudinal strain (RV ɛ) indices can add to differential diagnostic protocols in participation cardiac screening (PCS)
Cardiac chamber enlargement and impaired functional parameters can be associated with pathological disease, cardiomyopathy including hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) [10]
Summary
Echocardiography has advanced our knowledge and understanding of the structural and functional adaptation that occurs in the athletes’ heart (AH) in response to chronic training [1–4]. Cardiac chamber enlargement and impaired functional parameters can be associated with pathological disease, cardiomyopathy including hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) [10]. This creates a diagnostic dilemma or ‘grey zone’ between normal physiological adaptation and potential pathological disease [10]. The most commonly used ɛ imaging modality for assessment of cardiac mechanics is STE This technique allows for estimation of myocardial ɛ to identify local shortening, thickening and lengthening of the myocardium and provides quantitative measurements of LV regional and global function [14]. In a study of DCM patients, decreased GLS was observed even in the setting of
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