Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. 103 consecutive male elite Norwegian soccer players and 46 age-matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans-mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by colour M-mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base-to-apex gradient of LS. Colour M-mode and TDI-derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4 ± 2.8 vs controls 101.9 ± 5.2 deg/s, P<0.01). Diastolic untwisting rate (UTWR) was higher in players (-124.5 ± 4.2 vs -106.9 ± 6.7 deg/s) and peaked earlier during the cardiac cycle (112.7 ± 0.8 vs 117.4 ± 2.4% of systole duration, both P<0.05). Untwisting/twisting ratio (-1.48 ± 0.05 vs -1.11 ± 0.08; P <0.001) and untwisting performance (=UTR/TW; -9.25 ± 0.34 vs -7.38 ± 0.40 s-1, P<0.01) were increased in players. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete's heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy.
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