Myocardial Mechanics in Athlete's Heart

Advanced Myocardial Deformation Echocardiography for the Athlete's Heart Evaluation: Functional and Mechanistic Analysis

Echocardiographic assessment of the endurance athletes' heart remains challenging due to a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The lower range of normal values of lLeft ventricle systolic ejection fraction (LVEF) and global longitudinal strain (GLS) in athletes makes it difficult to differentiate changes related to adaptive remodelling or indicative of early cardiomyopathy.

This study aims to improve the assessment of athletes' hearts by identifying echocardiographic phenotypes, using a speckle tracking including temporal deformation pattern and layer-specific approach, and to define predictive factors of subtle LV systolic dysfunction and of mechanical LV abnormalities.

Study Overview

• Status: Completed
• Conditions: Athlete Heart
• Intervention / Treatment: Other: Echocardiography; Other: Cardiopulmonary exercise testing

Detailed Description

Healthy male athletes belonging to local clubs, who underwent a pre-participation medical evaluation at the University Hospital of Nancy between 2013 and 2020, will be screened. Clinical, echocardiographic and cardiopulmonary exercise testing data will be compared to a group of healthy men from the STANISLAS cohort. Subtle LV dysfunction will be defined by a GLS <17.5%.

• Study Type: Observational
• Enrollment (Actual): 191

Contacts and Locations

Study Locations

• France
  • Nancy, France, 54000
    • CHRU Nancy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Cross-sectional study, using data from young high-performance athletes referred to the cardiologic department of Nancy University Hospital for a pre-participation medical evaluation.

Description

Inclusion Criteria:

- athletes who underwent a pre-participation medical evaluation in the Nancy University Hospital between January 1st, 2013, and January 1st, 2020

Exclusion Criteria:

• female athletes,
• athletes followed for cardiomyopathy
• athletes who did not have transthoracic echocardiography (TTE) performed.

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Male Athletes; Athletes who underwent a pre-participation medical evaluation in the Nancy University Hospital between January 1st, 2013, and January 1st, 2020.	Other: Echocardiography; Transthoracic echocardiography; Other: Cardiopulmonary exercise testing; Cardiopulmonary exercise testing
Control Group; A subgroup of 161 participants in a population-based cohort (STANISLAS Cohort) restricted by age and sex to create a control group in the current analysis.	Other: Echocardiography; Transthoracic echocardiography; Other: Cardiopulmonary exercise testing; Cardiopulmonary exercise testing

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Multilayer (= epi- and endocardial) left ventricular global longitudinal strain using Speckle-tracking echocardiography	expressed in %	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age	years	Baseline
Height	meter	baseline
Weight	meter	baseline
BMI	kg/m²	baseline
Heart rate	bpm	baseline
Left ventricle indexed mass	g/m²	baseline
Left ventricular Ejection Fraction	using simpson's biplane method, expressed in %	baseline
left ventricular End-diastolic volume	ml	baseline
Cardiac Index	ml/min/m²	baseline
Maximal E-wave velocity and Maximal A-wave velocity	m/s	baseline
Left atrium End-systolic volume	ml/m²	baseline
left ventricular global longitudinal strain (peak G) assessed by Speckle-tracking echocardiography	expressed in %	baseline
PSI (pre stretch index) assessed by Speckle-tracking echocardiography	expressed in %	baseline
PST (postsystolic thickening) assessed by Speckle-tracking echocardiography	expressed in %	baseline
Peak VO2	L/min	baseline
Type of practiced sport	soccer, basketball, handball	baseline
Inter ventricular septum diameter	mm	baseline

Collaborators and Investigators

• Sponsor: Central Hospital, Nancy, France
• Collaborators: INSERM, UMR-1116; INSERM, CIC 1433
• Investigators: Principal Investigator: Nathalie Pace, MD, CHRU Nancy

Publications and helpful links

General Publications

• Spirito P, Pelliccia A, Proschan MA, Granata M, Spataro A, Bellone P, Caselli G, Biffi A, Vecchio C, Maron BJ. Morphology of the "athlete's heart" assessed by echocardiography in 947 elite athletes representing 27 sports. Am J Cardiol. 1994 Oct 15;74(8):802-6. doi: 10.1016/0002-9149(94)90439-1.
• Caselli S, Maron MS, Urbano-Moral JA, Pandian NG, Maron BJ, Pelliccia A. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol. 2014 Nov 1;114(9):1383-9. doi: 10.1016/j.amjcard.2014.07.070. Epub 2014 Aug 12.
• Schnell F, Matelot D, Daudin M, Kervio G, Mabo P, Carre F, Donal E. Mechanical Dispersion by Strain Echocardiography: A Novel Tool to Diagnose Hypertrophic Cardiomyopathy in Athletes. J Am Soc Echocardiogr. 2017 Mar;30(3):251-261. doi: 10.1016/j.echo.2016.11.013. Epub 2017 Jan 5.
• Abuli M, de la Garza MS, Sitges M. Differentiating Athlete's Heart from Left Ventricle Cardiomyopathies. J Cardiovasc Transl Res. 2020 Jun;13(3):265-273. doi: 10.1007/s12265-020-10021-8. Epub 2020 May 14.
• Santoro A, Alvino F, Antonelli G, Caputo M, Padeletti M, Lisi M, Mondillo S. Endurance and Strength Athlete's Heart: Analysis of Myocardial Deformation by Speckle Tracking Echocardiography. J Cardiovasc Ultrasound. 2014 Dec;22(4):196-204. doi: 10.4250/jcu.2014.22.4.196. Epub 2014 Dec 26.
• D'Ascenzi F, Solari M, Mazzolai M, Cameli M, Lisi M, Andrei V, Focardi M, Bonifazi M, Mondillo S. Two-dimensional and three-dimensional left ventricular deformation analysis: a study in competitive athletes. Int J Cardiovasc Imaging. 2016 Dec;32(12):1697-1705. doi: 10.1007/s10554-016-0961-6. Epub 2016 Aug 13.
• Huttin O, Girerd N, Coiro S, Bozec E, Selton-Suty C, Lamiral Z, Frikha Z, Kobayashi M, Argulian E, Narula J, Fraser AG, Rossignol P, Zannad F. Association Between Layer-Specific Longitudinal Strain and Risk Factors of Heart Failure and Dyspnea: A Population-Based Study. J Am Soc Echocardiogr. 2019 Jul;32(7):854-865.e8. doi: 10.1016/j.echo.2019.03.011. Epub 2019 May 16.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2021
• Primary Completion (Actual): January 1, 2022
• Study Completion (Actual): January 1, 2022

Study Registration Dates

• First Submitted: September 8, 2022
• First Submitted That Met QC Criteria: September 15, 2022
• First Posted (Actual): September 16, 2022

Study Record Updates

• Last Update Posted (Actual): August 30, 2023
• Last Update Submitted That Met QC Criteria: August 29, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: functional capacity; speckle tracking echocardiography; myocardial deformation; layer-specific strain
• Other Study ID Numbers: 2022PI064

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All of the individual participant data collected during the trial, after deidentification.
• IPD Sharing Time Frame: Immediately following publication. No end date.
• IPD Sharing Access Criteria: Researchers who provide a methodologically sound proposal.To achieve aims in the approved proposal. Proposals should be directed to n.pace@chru-nancy.fr.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No