Speckle Tracking Echocardiography for Assessment of Left Ventricular Remodeling in Soccer Athletes

Introduction: Speckle-tracking echocardiography (STE)-derived strain is a sensitive tool to detect early signs of exercise-induced cardiac remodeling in athletes, which may contribute to differentiate between physiological and pathological adaptation to sports. Objective: We aimed to assess the effect of regular athletic training on myocardial function assessed by STE in soccer players. Methods: We prospectively enrolled teenager soccer players who participate in regular training in a professional soccer team from Minas Gerais, Brazil. All asymptomatic athletes without known cardiovascular disease and with a structurally normal heart on transthoracic echocardiogram were included. Global longitudinal strain (GLS) by STE was performed in each athlete and measured offline using EchoPAC (GE) software. GLS was categorized according to absolute value |x| and GLS <16% was considered decreased, 16% to 18% borderline and >18% normal. Clinical, demographic and echocardiographic variables associated with reduced and borderline GLS were assessed by logistic regression. Results: The study population consisted of 352 male trained athletes with a mean age of 14 years (range 9 to 20), body mass index (BMI) of 20.4 ± 2.8 kg/m2, and left ventricular ejection fraction (LVEF) of 70 ± 6%. In the overall study population, the mean GLS value was -19.6 ± 2.2%, decreased in 13 athletes (3.7%) and borderline in 57 athletes (16.3%). In multivariable logistic regression analysis, BMI (odds ratio [OR] 1.38; 95% confidence interval [CI] 1.21 - 1.59; p<0.001), LVEF (OR 0.94; 95% CI 0.91 - 0.98; p=0.004), left atrial volume (OR 0.89; 95% CI 0.83 - 0.95; p=0.001), E/e' ratio (OR 1.52; 95% CI 1.07 - 2.11; p=0.019) and E/A ratio (OR 0.37; 95% CI 0.18 - 0.78; p=0.009) were independently associated with reduced and borderline GLS. The model was well calibrated and with good discrimination, yielding a C-statistic of 0.78 (95% CI 0.72 - 0.85). Conclusions: This study provides sport-specific GLS values in the setting of normal LVEF in young athletes. Determinants of abnormal GLS include diastolic and systolic echocardiographic parameters related to exercise adaptation. Decreased myocardial deformation by STE may reflect a forthright relaxed cardiac state rather than underlying pathology.