Left Ventricle Twisting in Athletes: A Comparison between Subjects with Bicuspid Aortic Valve and Tricuspid Ones

Abstract

Aim: In athletes with Bicuspid Aortic Valve (BAV) a slight but progressive left ventricle (LV) enlargement with a reduction of longitudinal strain values at basal segments of the same chamber, have been previously demonstrated. The aim of the study is to verify by deformation parameters any possible asymptomatic myocardial dysfunction in BAV athletes. Study Design: Cross-sectional study. Place and Duration of Study: Department of Sports Medicine (Emergency Unit) between June 2009 and July 2010. Methodology: The study protocol included all athletes investigated for a prime evaluation to enter the criteria for this particular study. 30 BAV athletes (aged 25± 3) and 30 Tricuspid Aortic Valve (TAV) athletes, regularly trained were submitted to an echocardiographic exam. From the short axis LV view images, the circumferential strain, rotation, twist, distinguished in the endocardial and epicardial component at the basal and apical level, were calculated by the speckle tracking (ST) multi-layer approach. This is a special assisted mode (AHSTM, Aided Heart Segmentation) to track the LV Endo/Epi myocardial points. Results: In BAV only the epicardial (5.74±1.4) and endocardial (8.64±4.0) apical rotation are significantly higher than in TAV (p<0.01) while the LV basal segments are at the lower limits. The endo/epi twist exams carried out in both BAV & TAV result normal. Conclusion: ST multi-layer approach improves the assessment of LV myocardial function in asymptomatic trained BAV athletes, where the major apical LV rotation values found seem to compensate for basal dysfunction in them. This confirms the persistence of a normal heart performance despite the mild LV chamber enlargement.