Endurance Training Minimizes Age-Related Changes of Left Ventricular Twist-Untwist Mechanics

Background: The aim of this study was to test the effect of endurance training on the age-related changes of left ventricular (LV) twist-untwist mechanics. Aging has been shown to induce a decline of diastolic function and more recently an impairment of twist-untwist mechanics, which constitutes an important factor for early diastolic suction and filling. On the other hand, endurance training has been shown to improve cardiac function. Methods: Speckle-tracking echocardiography was performed in 106 endurance-trained male athletes and 75 controls (age range 18-70 years), divided into three groups according to age. Results: From the younger to older age groups, progressive increases in LV apical rotation and twist angle and a decrease in LV untwisting rate during isovolumic relaxation time were observed. Athletes had lower systolic twist angles (P < .01) but higher untwist/twist ratios and LV untwisting rate during isovolumic relaxation time compared with controls, with the largest difference between senior groups (51 +/- 24% vs 42 +/- 22% in the young and 42 +/- 29% vs 24 +/- 25% in seniors, P < .001, respectively). The normal timing of untwisting rate occurring before radial displacement was preserved in athletes with increasing age, whereas it was blunted in controls. Conclusions: Endurance training does not prevent but minimizes changes in LV twist-untwist mechanics from young subjects to seniors. Athletes showed smaller increases of twist angle with age and smaller declines of LV untwisting rate during isovolumic relaxation time and untwist/twist ratio compared with controls. This training-improved preservation of LV twist-untwist mechanics is likely to play a key role for systolic-diastolic coupling and diastolic filling, particularly during exercise.