Morpho-functional characterization of cardiac chambers of young athletes of gymnastics by Transthoracic Echocardiography

Virgínia Fonseca, Diogo Colaço, Vanessa Neves


In response to the practice of intense and prolonged physical activity morphological and functional adaptations appear at the cardiovascular level, however, these physiological adaptations can be confused with pathological alterations. This study aimed to characterize, by transthoracic echocardiography, cardiac morphology and function, in young athletes of competitive gymnastics. This study was carried out in a population of athletes of feminine artistic gymnastics, with ages between 12 and 15 years old. All subjects (n = 8) underwent transthoracic echocardiography, following the defined study protocol. Statistical analysis of the study variables was performed using descriptive statistics and the results were considered statistically significant when p < 0.05. In the left cavities, no statistically significant differences were found in ventricular thickness, mass and diameter. On the other hand, there was a significant increase in the area of the left atrium. The increase of the left atrium is common in athletes due to increased pressure in the cavity during exercise and seems to be influenced by the type of training, mainly by the combination between isometric and isotonic training. Regarding the Diastolic Function, there was a significant increase of the E wave and the E/A Ratio. In several studies related to diastolic function in athletes, an increase in E-wave velocity and an increase in the E/A Ratio have been observed. These findings are suggestive of a supernormal diastolic function mediated by a combination of improved initial ventricular relaxation and increased left ventricular compliance. With this study, it was possible to conclude that in what respected the young female gymnastic contestants of the sample, all the parameters analysed by transthoracic echocardiography were within the limits of normality, when compared with the Guidelines. There were statistically significant differences for the mean reference value in the left atrial area and diastolic function.


Aksakal, E., Kurt, M., Oztürk, M., Tanboğa, I., Kaya, A., Nacar,T., Sevimli, S. & Gürlertop, Y. (2013). The effect of incremental endurance exercise training on left ventricular mechanics: a prospective observational deformation imaging study. The Anatolian journal of cardiology, 13(5), 432-438.

Aubert, A., Seps, B. & Beckers, F. (2003). Heart rate variability in athletes. Sports Medicine, 33(12), 889–919.

Baggish, A., Wang, F., Weiner, R., Elinoff, J., Tournoux, F., Boland, A., Picard, M., Hutter, A. & Wood, M. (2008). Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes. Journal of Applied Physiology, 104(4), 1121-1128.

Baggish, A., Yared, K., Weiner, R., Wang, F., Demes, R., Picard, M., Hagerman, F. & Wood, M. (2010). Differences in cardiac parameters among elite rowers and subelite rowers. Medicine and science in sports and exercise, 42(6), 1215–1220.

Bartkeviciene, A. & Baksiene D. (2007). Changes in morphometric parameters and function of left ventricle in child and adolescent athletes. Medicina (Kaunas), 43(3), 251-258.

Bhatla, P., Nielsen, J., Ko, H., Doucette, J., Lytrivi, I. & Srivastava, S. (2012). Normal values of left atrial volume in pediatric age group using a validated allometric model. Circulation. Cardiovascular imaging. 5(6), 791-796.

Bompa, T. (1990). Theory and Methodology of training. Iowa: Kenda ll Hunt Publishing Company.

Bu'Lock, F., Mott, M. & Martin, R. (1995). Left ventricular diastolic function in children measured by Doppler echocardiography: normal values and relation with growth. British heart journal, 73(4), 334-339.

Cantinotti, M., Scalese, M., Murzi, B., Assanta, N., Spadoni, I., De Lucia, V., Crocetti, M., Cresti, A., Gallotta, M., Marotta, M., Tyack, K., Molinaro, S. & Iervasi, G. (2014). Echocardiographic nomograms for chamber diameters and areas in Caucasian children. Journal of the American Society of Echocardiography, 27(12), 1279-1292.e2.

Claessens, P., Claessens, C., Claessens, M., Claessens, M. & Claessens, J. (2001). Supernormal Left Ventricular Diastolic Function in Triathletes. Texas Heart Institute journal, 28(8), 102-110.

D'Andrea, A., Caso, P., Sarubbi, B., Limongelli, G., Liccardo, B., Cice, G., D'Andrea, L., Scherillo, M., Cotrufo, M. & Calabrò, R. (2003). Right ventricular myocardial adaptation to different training protocols in top-level athletes. Echocardiography, 20(4), 329–336.

D'Andrea, A., La Gerche, A., Golia, E., Teske, A., Bossone, E., Russo, M., Calabrò, R. & Baggish, A. (2015). Right Heart Structural and Functional Remodelling in Athletes. Echocardiography, 32 (Suppl 1), S11–S22.

Deusen, A. (2008). Olympic Gymnastics: The Basics of Women’s Artistic Gymnastics. About Sports: Retrieved. Dec14:

Firoozi, S., Sharma, S. & McKenna, W. (2003). Risk of competitive sport in young athletes with heart disease. Heart, 89(7), 710-714.

Foster, B., Mackie, A., Mitsnefes, M., Ali, H., Mamber, S. & Colan, S. (2008). A novel method of expressing left ventricular mass relative to body size in children. Circulation, 117(21), 2769-2775.

Galderisi, M., Cardim, N., D'Andrea, A., Bruder, O., Cosyns, B., Davin, L., Donal, E., Edvardsen, T., Freitas, A., Habib, G., Kitsiou, A., Plein, S., Petersen, S., Popescu, B., Schroeder, S., Burgstahler, C, & Lancellotti, P. (2015). The multi-modality cardiac imaging approach to the Athlete’s heart: an expert consensus of the European Association of Cardiovascular Imaging. European heart journal cardiovascular Imaging, 16(4), 353-353r.

George K. & Somauroo, J. (2012). Left Ventricular Diastolic Function in Athletes. Deutsche Zeitschrift für Sportmedizin, 63(3), 63-68.

Georgopoulos, N., Theodoropoulou, A., Roupas, N., Rottstein, L., Tsekouras, A., Mylonas, P., Vagenakis, G., Koukkou, E., Armeni, A., Sakellaropoulos, G., Leglise, M., Vagenakis, A. & Markou K. (2012). Growth velocity and final height in elite female rhythmic and artistic gymnasts. Hormones (Athens), 11(1), 61-69.

Griffet, V., Finet, G., Di Filippo, S., Lantelme, P., Caignault, JR. & Guérarda, S. (2013). Le coeur d’athlète de l’adolescent: aspects électrocardiographiques et échocardiographiques. À propos de 107 sportifs français. Annales de Cardiologie et d’Angéiologie, 62(2), 116-121.

Hedman, K., Tamás, É., Henriksson, J., Bjarnegård, N., Brudin, L. & Nylander, E. (2015). Female athlete's heart: Systolic and diastolic function related to circulatory dimensions. Scandinavian journal of medicine & science in sports, 25(3), 372-381.

Henriksen, E., Landelius, J., Kangro, T., Jonason, T., Hedberg, P., Wesslén, L., Rosander, C., Rolf, C., Ringqvist, I. & Friman, G. (1999). An echocardiographic study of right and left ventricular adaptation to physical exercise in elite female orienteers. European Heart Journal, 20(4), 309–316.

João, A. & Filho, J. (2015). Somatotype and Body Composition of elite Brazilian Gymnasts. Science of Gymnastics Journal, 7(2), 45-54.

Kasikcioglu, E., Oflaz, H., Akhan, H. & Kayserilioglu, A. (2005). Right ventricular myocardial performance index and exercise capacity in athletes. Heart Vessels, 20(4), 147–152.

Koç, M., Bozkurt, A., Akpinar, O., Ergen, N. & Acartürk, E. (2007). Right and left ventricular adaptation to training determined by conventional echocardiography and tissue Doppler imaging in young endurance athletes. Acta cardiologica, 62(1), 13-18.

Koestenberger, M., Ravekes, W., Everett, A., Stueger, H., Heinzl, B., Gamillscheg, A., Cvirn, G., Boysen, A., Fandl, A. & Nagel, B. (2009). Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. Journal of the American Society of Echocardiography, 22(6), 715-719.

Lang, R., Badano, L., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F., Foster, F., Goldstein, S., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M., Rietzschel, E., Rudski, L., Spencer, K., Tsang, W. & Voigt, J. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1-39.

Maron B & Zipes D. (2005). 36th Bethesda Conference: Eligibility recommendations for competitive athletes with cardiovascular abnormalities. Journal of the American College of Cardiology, 45(8), 1313-1367.

Maron, B. & Pelliccia, A. (2006). The Heart of Trained Athletes: Cardiac Remodeling and the Risks of Sports, Including Sudden Death. Circulation, 114, 1633-1644.

Massidda, M., Toselli, S., Brasili, P. & Calò, C. (2013). Somatotype of Elite Italian Gymnasts, Collegium antropologicum, 37(3), 853–857.

Meško, D., Jurko, A., Vrlík, M., Novomeská, M., Horniak, E. & Dzurenková, D. (1993). Development of the left ventricular hypertrophy and dilation in adolescent ice hockey players evaluated with echocardiography. Sports Medicine, Training and Rehabilitation, 4(3), 177-188.

Moro, A., Okoshi, M., Padovani, C. & Okoshi, K. (2013). Doppler echocardiography in athletes from different sports. Medical science monitor: international medical journal of experimental and clinical research, 19, 187-193.

Pagourelias, E., Kouidi, E., Efthimiadis, G., Deligiannis, A., Geleris, P. & Vassilikos, V. (2013). Right Atrial and Ventricular Adaptations to Training in Male Caucasian Athletes: An Echocardiographic Study. Journal of the American Society of Echocardiography, 26(11), 1344-1352.

Pelliccia, A., Maron, B., Culasso, F., Spataro, A. & Caselli, G. (1996). Athlete's heart in women. Echocardiographic characterization of highly trained elite female athletes. JAMA, 276(3), 211–215.

Pelliccia, A., Maron, B., Di Paolo, F., Biffi, A., Quattrini, F., Pisicchio, C., Roselli, A., Caselli, S. & Culasso, F. (2005). Prevalence and clinical significance of left atrial remodelling in competitive athletes. Journal of the American College of Cardiology, 46(4), 690–696.

Pluim, B., Zwinderman, A., van der Laarse, A. & van der Wall, E. (2000). The Athlete’s Heart: A Meta-Analysis of Cardiac Structure and Function. Circulation, 101(3), 336-344.

Prakken, N., Velthuis, B., Teske, A., Mosterd, A., Mali, W. & Cramer, M. (2010). Reference values for athletes and nonathletes corrected for body surface area, training hours/week and sex. European journal of cardiovascular prevention and rehabilitation, 17(2), 198–203.

Reece, C., Miller, A., Lindquist, R., Mulvagh, S., O'Leary, P., Cetta, F. & Eidem, B. (2011). Impact of Long-Term High Intensity Athletic Training on Right Ventricular Myocardial Function in Elite High School Athletes. Circulation, 124(Suppl 21): A10665.

Rudski, L., Lai, W., Afilalo, J., Hua, L., Handschumacher, M., Chandrasekaran, K., Solomon, S., Louie, E. & Schiller, N. (2010). Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. Journal of the American Society of Echocardiography, 23(7), 685-713.

Silva, AP. (2011). Deformação miocárdica em atletas de diferentes modalidades – Um estudo por 2D Speckle Tracking: projecto de investigação. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa.

Venckunas, T., Lionikas, A., Marcinkeviciene, J., Raugaliene, R., Alekrinskis, A. & Stasiulis, A. (2008). Echocardiographic parameters in athletes of different sports. Journal of sports science and medicine, 7(1), 151-156.

Wilhelm, M. & Seiler, C. (2012). The athlete’s heart: different training responses, gender and ethnicity dependencies. Cardiovascular Medicine, 15(3), 69–78.

Zetaruk, M. (2000). The young gymnast. Clinics in sports medicine, 19(4), 757-780.


  • There are currently no refbacks.

RNH | Health Research Unit | School of Health Sciences | ISSN 2183-6841