Detection of changes in diastolic function by pulmonary venous flow analysis in women athletes

Background Left ventricular cavity dimension, wall thickness, relaxation, a nd filling increase with exercise training and have a role in enhancing phy sical performance. We probed whether changes in diastole may develop separa tely from those in cardiac morphometry and still contribute to improve phys ical performance. Challenging diastole by preload reduction with standing a nd integrating mitral flow analysis with the pulmonary venous flow analysis were viewed as a means for detecting fine diastolic variations. Methods Patterns of mitral, tricuspid, and pulmonary venous flow were evalu ated by echo Doppler imaging in the supine and standing positions in 11 lon g-distance runner women athletes participating in training programs and hav ing no or very mild cardiac morphologic alterations and were compared with those in 11 healthy women active in daily life not participating in trainin g programs. Maximal exercise tolerance was tested in both groups with a tre admill with use of the standard Bruce protocol. Results Echocardiographic left ventricular mass index and mitral and pulmon ary flow patterns in athletes and controls were similar while they were sup ine. Major (P < .01) percent variations and differences between athletes an d controls with standing were smaller decrease in right (-12% +/- 5% vs -29 % +/- 5%) and left ventricular (-3% +/- 1% vs -9% +/- 2%) dimensions and st roke volume (-7% +/- 4% vs -23% +/- 4%), smaller lengthening of early mitra l deceleration (+7% +/- 4% vs +18% +/- 5%), and isovolumic retaxation (-3% +/- 5% vs +15% +/- 7%) times. Athletes showed greater reduction in pulmonar y S wave peak velocity (-25% +/- 10% vs -12.5% +/- 7%) and time velocity in tegral (Si) (-50% +/- 9% vs -21% +/- 8%), greater increases in pulmonary ve nous diastolic (D) wave peak velocity(+20% +/- 9% vs +12% +/- 10%, meters p er second), and time velocity integral (Di) (+81% +/- 16% vs +27% +/- 14%) and greater decrease of S/D(-30% +/- 6% vs -18% +/- 5%) and Si/Di (-70% +/- 10% vs -33% +/- 5%) ratios. At multivariate analysis standing Si/Di was th e strongest independent predictor of better exercise tolerance (peak exerci se time 1035 +/- 88 sec in athletes, 751 +/- 20 in controls). Conclusions Pulmonary flow analysis in athletes while standing can detect c hanges in diastolic function that are dissociated from apparent left ventri cular morphologic alterations, are undetected in the supine position, and m ay, in part, determine exercise performance.