Geert Kleinnibbelink

Cardiac Remodelling in Olympic Athletes 4 93 Conventional measurements. Cardiac structural and functional measurements were made according to the current guidelines for cardiac chamber quantification. 12 Regarding the left heart, we examined the following structural and functional indices: wall thickness of the septum (IVSd) and posterior wall (PWd), internal cavity diameter at end-diastole (LVIDd), LV mass (LVM), anteroposterior diameter of the left atrium (LA), LA volume by the disk summations technique in apical 4-chamber (A4C) and apical 2-chamber (A2C) view, modified Simpson’s left ventricular ejection fraction (LVEF), tissue Doppler imaging (TDI) of the mitral annulus (s’, e’ and a’) and trans-mitral Doppler (E, A and E/A ratio). Regarding the right heart, following structural and functional indices were determined: basal and mid-cavity end-diastolic diameters, RV end-diastolic area (RVEDA), RV end-systolic area (RVESA), RV outflow tract (RVOT) diameter at the proximal level in the parasternal long- axis (PLAX) and parasternal short-axis (PSAX) view, right atrial (RA) area, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), TDI of the tricuspid annulus. All LV and RV structural indices were allometrically scaled to body surface area (BSA) according to the laws of geometric similarity. 13 Mechanics. Images were acquired specifically for speckle tracking. This involved the optimization of frame rates between 40 and 90 frames s − 1 , depth to ensure adequate imaging of the chamber of interest, a focal zone at mid-cavity to reduce the impact of beam divergence and gain, compression and reject to ensure endocardial delineation. Ventricular and atrial mechanics. The A4C view was utilized for LV, LA and RA global longitudinal strain and the RV focused view for the RV longitudinal strain. The LV short-axis (SAX) views (basal, mid and apical) were utilized for radial, circumferential strain and twist. Valve closure times were determined from the respective pulsed wave Doppler signals. For all compartments (LV, LA, RV, RA), the myocardium was manually traced and adjusted so that the region of interest (ROI) incorporated all of the wall thickness, while avoiding the pericardium. The region of interest was divided into six myocardial segments, providing segmental strain curves and a global longitudinal strain curve as an average of all six segments. In order to obtain peak LV circumferential strain, peak LV radial strain and peak apical and basal rotation, a full-thickness ROI of the mid-, basal- and apical-SAX views, which was divided into six segments, was selected. In addition, raw strain values