Tissue Doppler Imaging can Distinguish Pathological from Physiological Left Ventricular Hypertrophy in Master Athletes with Mild Hypertension

Abstract

PURPOSE: Left ventricular wall thicknesses at transthoracic echocardiography are often increased in master athletes, a growing population of trained people observed in Sport Medicine. The observed Left Ventricular Hypertrophy (LVH) may be a physiological remodeling induced by physical training or the expression of a pathological hypertrophy because of the mild hypertension often relieved in this middle-aged population. The conventional Pulsed Wave (PW) Doppler analysis of diastolic function, always affected in pathological LVH, is poorly useful to distinguish between physiological and pathogical LVH. Aim of this study is to evaluate the role of pulsed wave Tissue Doppler Imaging (TDI) in differentiating pathological from physiological LVH in middle-aged population. METHODS: We have selected a group of 80 master athletes with mild hypertensive state and a group of 80 sedentary subjects suffering from essential hypertension but with a normal diastolic function on standard echocardiography. The subjects of the two groups were comparable by sex male, age (50.3 ± 10.0 vs 51.6 ± 7.9 years; P >.05), increased left ventricular wall thicknesses and mass index (134.4 ± 19.7 vs 134.5 ± 22.1 gr/m2; P >.05). The diastolic function indexes by PW technique were in the range of normality for both groups (E/A 1.2 ± 0.4 vs 1.0 ± 0.4, P <.05). RESULTS: The pulsed wave TDI study of diastolic function immediately separated the two groups. While in master athletes the diastolic TDI parameters have been within the range of normality (E' 9.4 ± 3.1 cm/sec; E/E' 7.8 ± 2.1), in hypertensive group these parameters have resulted constantly altered, with median values and variation ranges always out of normal validated limits (E' 7.2 ± 2.4 cm/sec; E/E' 10.6 ± 3.2), with E' and E/E' statistically different in the two groups (P <.001). CONCLUSIONS: Our study showed that TDI technique is an easy and validated method for the accurate assessment of diastolic function because of its sensibility and specificity in differentiating the normal from pseudonormal diastolic pattern, and its superiority from WP Doppler in differentiating pathological from physiological LVH in middle-aged population. It turns to be an useful instrument to distinguish physiological from pathological LVH, particularly useful when a sportive idoneity certification is required by legal medical legislation, such as in Italy.