Insight the athlete's heart: role of vortex analysis

Background: Athlete's heart has been extensively studied, particularly regarding global myocardial remodeling in normal systo-diastolic 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: A group of 23 highly trained athletes was studied using 2D standard and deformation echo parameters and vortex examination. A dedicated software (HyperDoppler; ESAOTE) defined geometrical and dynamic vortex parameters (area, length, depth, energy dissipation, vorticity fluctuation, kinetic energy fluctuation). The data obtained were compared with a group of 26 active non-athletes and a group of 23 normal subjects. BMI 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). Results: Indicized left ventricular mass (iLV) 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 (energy dissipation= 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.