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is impaired (E/A < 1 with a prolonged deceleration time). By using Pulsed TDI,
early diastolic velocity (e’) and the ratio e’/a’ of basal septal and basal lateral wall
are increased in athletes. Moreover, it has been demonstrated that LV inferior wall e’
correlates with LV end-diastolic diameter demonstrating that in endurance athlete
the LV cavity enlargement induces a proportional improvement of LV relaxation [ 2 ].
In endurance athletes, the novel technique of STE have been also used to analyze the
LV function in athlete. In a group of professional soccer athletes it was found a
reduction of global longitudinal strain at rest that is compensated by an increased
radial and circumferential strain [ 59 ]. However, it has been described lower apical
radial strain and lower twisting at rest in cyclists and not in sedentary controls [ 2 ].
These studies demonstrate that the athlete’s heart adaptation at rest is different from
that of sedentary controls and also that is loading dependent. Moreover, different
type of sports determine different pattern of strain modification (Fig. 2.5).
There are many data of LV chronic response to exercise, but about the adaptationof left ventricle in the acute phase of post exercise, there are few and conflicting data.
Immediately after an intense physical exercise, it is reported an increase of both
Troponin and Brain Natriuretic Peptide that indicates a “cardiac fatigue” [ 16 , 17 ].
Fig. 2.5 Echocardiographic analysis of top-level endurance athlete, showing increased left ven-
tricular cavity by M-mode (A) and B-mode, enlarged right ventricular (RV) outflow tract (C),
super-normal diastolic function both at global (D) and regional (E) level, and normal myocardial
deformation by global strain analysis (F)
A. D’Andrea et al.