An Independent Marker of Myocardial Function in Athlete’s Heart: Role of Vortex Analysis in Triathlon

Aims: Athlete’s heart has been extensively studied, particularly regarding global myocardial remodeling in normal systodiastolic function and supernormal deformation reserve. Based on specific morphological characteristics, it is commonly classified as eccentric and concentric remodeling; however, the recent interest in echocardiography lies in the dynamicity of the vorticity flow inside the LV chamber, primarily correlated with diastolic function. This study aims to verify the potential additional contribution of vortex analysis in characterizing the athlete’s heart. Methods and Results: A group of 23 highly trained athletes was studied using two-dimensional standard and deformation echo parameters and vortex examination. A dedicated software (HyperDoppler-ESAOTE) defined geometrical and dynamic vortex parameters (area, length, depth, energy dissipation [ED], vorticity fluctuation, and kinetic energy fluctuation). The data obtained were compared with a group of 26 active nonathletes and a group of 23 normal subjects. Body mass index differed among the three groups, with higher values in normal subjects (normal = 27.2 ± 5.7; active = 22.9 ± 2.6; triathletes = 22.1 ± 1.8; P = 0.01). Indexed left ventricle mass was significantly higher in triathletes (triathletes = 96.9 ± 14.9; active = 87.6 ± 15; normal = 79.5 ± 15.7; P = 0.003) as twist (triathletes = 12.3 ± 3.9; active = 9.8 ± 3.7; normal = 8.1 ± 3.1; P = 0.001), expressing a supernormal apical reserve. Diastolic function was normal in both groups. In the presence of normal geometrical vortex data, vortex energetic parameters were significantly higher in triathletes (ED = 1.10 ± 0.41, P < 0.001; vorticity fluctuation = 0.89 ± 0.04, P < 0.001; kinetic energy fluctuation = 1.01 ± 0.08, P < 0.001). Conclusions: Vortex analysis complements the morphological remodeling of the athlete’s heart. It can contribute to defining the effects of training intensity and energy consumption. Future research will focus on potential modifications in different sports.