Valutazione della riserva contrattile del ventricolo sinistro in atleti con ridotta funzione sistolica

Abstract

Background: In daily practice, distinguishing between the physiological cardiac remodeling in athletes, characterized by en-largement of the left ventricle (LV), from the initial stages of dilated cardiomyopathy, may be challenging, particularly in pres-ence of a mild reduction of systolic function. Aims: Aim of the study was to evaluate the contractile reserve of the LV with the stress (exercise) echocardiography in athletes with reduced ejection fraction (EF) at rest. Methods: The study population comprised 27 elite athletes (26 M and 1 F) - mean age: 25 ± 5 years, with a mildly reduced LV sys-tolic function (EF ≥ 45, < 55%). The athletes underwent a exercise echocardiogram, in an upright position, until exhaustion. During the test, LV images were acquired from the apical 4 and 2 chambers views, from rest to peak of the effort, and the EF was (with the Simpson biplane method) and stroke volume (SV) were calculated. Data were analyzed independently by two operators. Results: Athletes showed an increase in EF (ΔEF = 19.1 ± 4.7%), from the baseline value of 51.3 ± 2.1% to 70.5 ± 4.6% at the peak of the effort. The increase in the SV at the peak of the effort (ΔSV) was 20.3 ± 12.4 ml, suggestive for a preserved contractile reserve of the LV. Conclusions: In athletes with a mild reduction of LVEF at rest (FE ≥ 45, < 55%) evaluation of systolic function during exercise with a stress echocardiogram is advisable. The increase in EF by 19% and SV by 20 ml characterize the LV response to exercise in athletes otherwise free of cardiac or systemic disease and may represent a useful criterion in the differential diagnosis between the athlete's heart and dilated cardiomyopathy.