Published Online
on May 18, 2009

A more recent version of this article appeared on July 1, 2009

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Original Article

Alteration in Left Ventricular Strains and Torsional Mechanics after Ultra-Long Duration Exercise in Athletes

Stéphane Nottin^1,3; Grégory Doucende¹; Iris Schuster–beck²; Stéphane Tanguy¹; Michel Dauzat² and Philippe Obert¹

¹ Laboratoire de Physiologie des Adaptations Cardiovasculaires à l'Exercice, Avignon, France;
² Montpellier I University & Nîmes University Hospital Center, Nîmes, France

³ E-mail: stephane.nottin{at}univ-avignon.fr

Background—Numerous studies have reported evidence of cardiac injury associated with transient left ventricular (LV) systolic and diastolic dysfunction following prolonged and strenuous exercise. We used 2D ultrasound speckle tracking imaging (STI) to evaluate the effect of an ultra–long duration exercise on LV regional strains and torsion. We speculated that systolic dysfunction following exercise is associated with depressed LV strains and torsion, and diastolic dysfunction results from decreased and delayed untwisting, a key factor of LV suction and early filling.

Methods and Results—Twenty three triathletes underwent conventional and STI echocardiography at rest before and immediately after an ultra–long distance triathlon. Measurements included LV longitudinal, circumferential and radial strains, LV rotations and LV torsion. After the race, LV systolic dysfunction was characterized by a decrease in LV longitudinal, radial and circumferential strains, especially for apical radial strains (44.6 ± 15.1% versus 31.1 ± 13.8%, P<0.001). Peak torsion was slightly decreased (8.3 ± 5.1° versus 6.4 ± 3.9°, respectively, P=0.09) and significantly delayed (91 ± 18% versus 128 ± 31% of systolic duration, P<0.001) beside end–ejection. Peak untwisting was also depressed, and delayed beside isovolumic relaxation.

Conclusions—This study documented major alterations in cardiac strains and torsion after an ultra–long distance triathlon. LV systolic strains were depressed but not delayed, whereas twisting was decreased and delayed. This altered pattern hampered the rapid untwisting during isovolumic relaxation phase, reducing LV diastolic suction and early filling.

Key Words: echocardiography • exercise • left ventricular dysfunction • left ventricular strains • speckle tracking imaging • 2D speckle echocardiography • cardiac dysfunction