Myocardial Mechanics in Athlete's Heart

Study Overview
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Brief Summary
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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.

Detailed Description
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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%.

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

Conditions
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Athlete Heart

Intervention / Treatment
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* Other: Echocardiography
* Other: Cardiopulmonary exercise testing


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Male Athletes<br>Athletes who underwent a pre-participation medical evaluation in the Nancy University Hospital between January 1st, 2013, and January 1st, 2020. | Other: Echocardiography<br>* Transthoracic echocardiography<br>Other: Cardiopulmonary exercise testing<br>* Cardiopulmonary exercise testing<br>|
| Control Group<br>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<br>* Transthoracic echocardiography<br>Other: Cardiopulmonary exercise testing<br>* Cardiopulmonary exercise testing<br>|

What is the study measuring?
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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 | 
| Type of practiced sport | soccer, basketball, handball | baseline | 
| Inter ventricular septum diameter | mm | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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functional capacity, speckle tracking echocardiography, myocardial deformation, layer-specific strain