Relationship between cardiac deformation parameters measured by cardiovascular magnetic resonance and aerobic fitness in endurance athletes

Abstract

Background: Athletic training leads to remodelling of both left and right ventricles with increased myocardial mass and cavity dilatation. Whether changes in cardiac strain parameters occur in response to training is less well established. In this study we investigated the relationship in trained athletes between cardiovascular magnetic resonance (CMR) derived strain parameters of cardiac function and fitness.

Methods: Thirty five endurance athletes and 35 age and sex matched controls underwent CMR at 3.0 T including cine imaging in multiple planes and tissue tagging by spatial modulation of magnetization (SPAMM). CMR data were analysed quantitatively reporting circumferential strain and torsion from tagged images and left and right ventricular longitudinal strain from feature tracking of cine images. Athletes performed a maximal ramp-incremental exercise test to determine the lactate threshold (LT) and maximal oxygen uptake (V̇O2max).

Results: LV circumferential strain at all levels, LV twist and torsion, LV late diastolic longitudinal strain rate, RV peak longitudinal strain and RV early and late diastolic longitudinal strain rate were all lower in athletes than controls. On multivariable linear regression only LV torsion (beta = -0.37, P = 0.03) had a significant association with LT. Only RV longitudinal late diastolic strain rate (beta = -0.35, P = 0.03) had a significant association with V̇O2max.

Conclusions: This cohort of endurance athletes had lower LV circumferential strain, LV torsion and biventricular diastolic strain rates than controls. Increased LT, which is a major determinant of performance in endurance athletes, was associated with decreased LV torsion. Further work is needed to understand the mechanisms by which this occurs.

Keywords: Aerobic capacity; Athlete; Cardiovascular magnetic resonance; Feature tracking; Lactate threshold; Tissue tagging.

Fig. 1

Average apical rotation (red), basal (blue) rotation and twist (green) of the left ventricle of 35 endurance athletes (a). Each point represents mean rotation/twist and time in the cardiac cycle corrected to end-systole, error bars represent standard error of mean rotation/twist. Tagged images of anticlockwise apical (a) systolic rotation (yellow and red) and clockwise basal (c) rotation (green and blue)

Fig. 2

Average LV longitudinal strain rate from 35 endurance athletes (a). Each point represents mean longitudinal strain rate at each point in the cardiac cycle corrected to end-systole, error bars represent 95 % confidence interval of mean strain. Peak systolic strain rate (SSR), early diastolic strain rate (EDSR) and late diastolic strain rate (LDSR). SSFP cine image at end diastole showing manually drawn endocardial and epicardial contours (b). Feature tracked end systolic image (c)

Fig. 3

Plots showing the mean ± standard error of rotation/twist of the 8 athletes in the lowest quartile of LT (left) and 8 in the highest quartile of LT (right). Peak twist was lower in athletes in the highest quartile of LT (8.5 ± 2.9 vs. 12.9 ± 2.6° P = 0.008) which was secondary to a loss of apical rotation (1.0 ± 3.3 vs. 6.0 ± 3.1° P < 0.001). Basal rotation was not different between the groups 6.5 ± 1.4 vs. 6.1 ± 2.6° P = 0.75