Left Ventricular Strain Modifications after Maximal Exercise in Athletes: A Speckle Tracking Study

Purpose The increase in systolic indexes from rest (R) to exercise is achieved by combination of enhanced heart rate ( HR ) and stroke volume ( SV ). Aim of this study was to evaluate left ventricular ( LV ) longitudinal, circumferential, and torsional components immediately after a maximal intensity exercise ( ME ) by speckle tracking echocardiography ( STE ). Methods Twenty‐seven male water polo players performed an ME that consisted of 6 repeats of 100 m freestyle swim sets. An echocardiographic examination was performed before and after ME . STE was performed to obtain the analysis of LV myocardial deformation. Results There were no differences between R and ME regarding LV longitudinal strains ( PVLS ). Apical circumferential LV strain ( AVCS ) and LV longitudinal strain rate ( SR ) increased at ME with respect to R (R: −23.1 ± 4.9%; ME: −28.4 ± 7.6%, P < 0.05; R: −1.1 ± 0.1/sec, ME: −1.5 ± 0.2/sec, P < 0.01). LV twisting ( LVT ) and untwisting ( UTW ) increased at ME (R: 7.9 ± 2.4°, ME: 14.2 ± 3.2°, P < 0.001; R: −107.2 ± 47.4; ME : −158.5 ± 61.5 °/sec; P < 0.01). At ME , apical rotation (Arot) had higher values than R values (5.4 ± 3.0°; 10.0 ± 6.0°; P < 0.01) and time‐to‐peak ( TTP ) of apical segments are earlier than all TTP . SV was related to LVT (r = 0.56, P = 0.01), AVCS (r = −0.59, P = 0.005) and Arot (r = 0.46, P = 0.04). At multivariate analysis, AVCS was the independent predictor of SV ( β  = −0.58; P < 0.05). Conclusions Apical fibers and LVT give the main contribution to systolic components at ME . The storage of energy during LVT , released during early diastole, seems to be a fundamental mechanism to support diastolic filling during maximal exercise.