Maria Concetta Robertina Vono

Speckle tracking for left ventricle performance in young athletes with bicuspid aortic valve and mild aortic regurgitation.

AIMS Longitudinal peak systolic strain (LPSS) quantifies regional and global heart function. Few data are available on left ventricle (LV) performance in young athletes with bicuspid aortic valve (BAV), where a pattern of mild aortic insufficiency is relatively frequent, and the ejection fraction (EF) is often normal for a long time. We report the measurement of LV strain in young BAV athletes. METHODS AND RESULTS Three groups (20 athletes with BAV, 20 healthy athletes, and 20 sedentary healthy subjects, all aged 25 +/- 3 years) underwent standard echo examination to evaluate LPSS at the basal and medium-apical segments of the lateral wall (LW) and interventricular septum (IVS) of the LV. LPSS was within the normal range; however, in BAV athletes, the LPSS of the basal segments tended to be lower (S%IVS(basal), -17.7 +/- 2.7; S%LW(basal), -14.2 +/- 2.2; S%IVS(med-apic), -21 +/- 3.5; S%LW(med-apic), -18.8 +/- 4.2), producing a gradient from basal to apical regions. The EF was normal in all subjects. CONCLUSION Young trained BAV athletes have normal LV performance. Nevertheless, these athletes tend to have lower strain than healthy subjects in the LV basal segments. The clinical implications of this finding are uncertain and require further investigation.

Bicuspid aortic valve in competitive athletes

Aim: Bicuspid aortic valve (BAV) is a common congenital cardiac condition. The presence of BAV in non-elite athletes has been poorly investigated; it is usually asymptomatic until valvular stenosis, regurgitation or other vascular alterations are evident. Design: Over a three-year period, 2273 competitive athletes were consecutively investigated with transthoracic echocardiography. The traditional parameters, the aortic root dimensions at four levels and the systolic and diastolic flow of aortic valve, were studied with continuous Doppler according to the echo guidelines. Setting: The study protocol included all the non-elite athletes investigated for the first evaluation to obtain eligibility. Patients: 2273 competitive athletes aged 8–60 years from several sports and regularly trained were evaluated with anamnesis, clinical check-up and echocardiography in order to exclude subjects with systemic or congenital heart disease. Results: BAV was diagnosed in 58 athletes (2.5%). Of these, nine had normal valvular function, 47 had abnormal valvular function with mild–moderate aortic regurgitation, and two had moderate stenosis. Aortic root dimensions at all levels were significantly greater in athletes with BAV than in athletes with a normal tricuspid valve. No relation was found with age, body surface area, aortic regurgitation or years of training. Conclusions: BAV is a relatively common congenital cardiac disease in athletes and commonly asymptomatic for a long time. This study suggests the usefulness of evaluating young athletes using echocardiography at least once when they start their sporting activity.

ACE I/D polymorphism and cardiac adaptations in adolescent athletes

PURPOSE The aim of this cross-sectional study was to determine whether there is a correlation between left ventricular hypertrophy (LVH) and angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism in adolescent athletes. METHODS Seventy-five competitive soccer players (aged 15 +/- 1.2 yr) and 52 untrained control subjects (aged 15 +/- 1.6 yr) were examined with echocardiography (echo) and bioelectrical impedance analysis. The ACE genotype of all subjects was determined by PCR and correlated with left ventricular mass (LVM) indices. RESULTS Allele frequencies were comparable between athletes and controls. Body surface area (BSA), fat-free mass (FFM), and all mean echo measurements were significantly greater in athletes than in controls. LVM and LVM indices for both BSA and FFM were all significantly greater in athletes than in controls (LVM 195.3 +/- 32 g vs 165.3 +/- 37.6 g; LVM/BSA 115.5 +/- 18.9 g x mq(-1) vs 95 +/- 18.2 g x mq(-1); LVM/FFM 3.5 +/- 0.5 vs 3 +/- 0.54, P < 0.001 for the three variables). Left ventricular hypertrophy was found in 17 (23%) athletes. There was no correlation between ACE I/D polymorphism and athletes with LVH as the II and DD genotype frequencies were identical (41%). However, in athletes with LVH, the presence of the D allele was associated with a greater LVM index than compared to homozygous II genotype (LVM = 145 +/- 7.6 g x mq(-1) in DD+ID group vs 135 +/- 2.9 g x mq(-1) in II group, P = 0.008). CONCLUSIONS The results of the study show that significant changes occur in cardiac morphology and function in adolescent athletes. Interestingly, the ACE I/D polymorphism was associated with the degree of cardiac hypertrophy but not with the occurrence of LVH itself.

Noninvasive Evaluation Of Right Ventricle Systolic Pressure During Dynamic Exercise by Saline-Enhanced Doppler Echocardiography in Progressive Systemic Sclerosis:

Progressive systemic sclerosis (PSS) is characterized in its first phases by vascular damage. Lungs are involved in two thirds of patients with initial progressive destruction of the capillary bed and consequent reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interest to have early information about the pressure of the pulmonary circulation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms. The aim of the study was to evaluate by a noninvasive method, saline-enhanced Doppler echocardiography, the behavior of the right ventricular systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest. Nine patients (7 women and 2 men) with PSS, aged 55.7 ±8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. Subjects underwent Doppler echocardiographic examination at rest and during exercise. Right ventricular systolic pressure was evaluated by saline- enhanced Doppler technique, at rest and throughout exercise. (continued on next page) At rest the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were still normal (40.7 ±2.2 mmHg); in the others pathologic values were recorded (59.8 ±3.9 mmHg). In the control group values were always normal (35.6 ±4.6 mmHg). In our study the saline-enhanced Doppler echocardiography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, both at rest and during exercise; it could be useful in monitoring the pulmonary vascular damage in patients with PSS.

Left Ventricle Twisting in Athletes: A Comparison between Subjects with Bicuspid Aortic Valve and Tricuspid Ones

Aim: In athletes with Bicuspid Aortic Valve (BAV) a slight but progressive left ventricle (LV) enlargement with a reduction of longitudinal strain values at basal segments of the same chamber, have been previously demonstrated. The aim of the study is to verify by deformation parameters any possible asymptomatic myocardial dysfunction in BAV athletes.