Characteristics of Left Ventricular Segmental Hemodynamics Evaluated by Wall Shear Stress in Elite Female Ice Hockey Athletes

Objective: To investigate the intraventricular segmental hemodynamics of the left ventricle in elite female ice hockey athletes. Methods: 53 female ice hockey athletes（27 elite athletes and 26 low-level athletes） and 24 healthy subjects were recruited in this study. The two-dimensional structure of the left ventricle（LV）, intraventricular relative pressure difference（IVPD） and segmental wall shear stress（WSS） in LV apical two-, three-, and four-chamber view were noninvasively measured by using vector flow mapping based on echocardiography. The differences of WSS at the time phase of peak IVPD during the rapid ejection, late systole and rapid filling among groups, and the correlations between WSS, training level, and LV structural parameters were analyzed. Results: 1) The LV mass index（LVMi）, LV end diastolic volume index（LVEDVi） and LV end systolic volume index（LVESVi） in elite female ice hockey athletes were significantly higher than that of controls, but the relative wall thickness index（RWTi） was significantly lower in elite female ice hockey athletes compared with control group. 2) During the rapid ejection phase,the WSS of apical lateral（ApL） segment was significantly higher in elite female athletes than that of low-level athletes（P=0.029）.During the late systole phase, WSS of ApL segment（P=0.005） and mid inferolateral（MIL P=0.008） segment were significantly lower in elite female athletes than those of low-level athletes; in addition, the WSS in the mid inferoseptal（MIS） segment was significantly lower in elite female athlete than that of low-level athletes（P=0.027） and controls（P=0.046）. 3) The WSS of ApL segment during rapid ejection was negatively correlated with RWTi, and positively correlated with training level. The WSS of ApL and MIL segments during late systole phase appeared negatively correlated with LVMi, LVEDVi and LVESVi; the WSS of MIL and MIS segments during late systole phase were negatively correlated with training level. Conclusions: 1) The LV structure of elite female ice hockey athletes is physiologically enlarged, and the intraventricular hemodynamics were optimized segmentally during systole; 2) long-term professional training promotes the physiological adaptation of athletes’ heart structure through segmental hemodynamics. The results can provide theoretical basis for the hemodynamic mechanism of the formation of athlete’s heart, and provides references for the prevention of the development of pathological remodeling in athletes’ heart.