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Background: Intensive training induces two morphological myocardial typologies of athlete’s heart. Endurance training (ET)induces eccentric remodeling, bradycardia and better diastolic filling. Strength training (ST) determines concentric chamberremodelling maintaining a normal heart rate (HR). Aim of the study was to compare ET and ST athletes’ heart using speckletracking echocardiography (STE). Methods: 33 professional ET, 36 ST athletes, and 17 healthy controls (CT) were enrolled. All subjects underwent standardtransthoracic echocardiography at rest and STE. Results: In ET group, HR was lower than ST group and CT group (p < 0.001; p < 0.01). ET group had higher E/A ratio thanST group and CT group (p < 0.01; p < 0.001). The left ventricular apical circumferential strain in ET group was lower than STgroup and CT group (-21.6 ± 4.1% vs. -26.8 ± 7.7%, p < 0.05; vs. -27.8 ± 5.6%, p < 0.01). ET group had lower left ventriculartwist (LVT) and untwisting (UTW) than ST group (6.2 ± 0.1° vs. 12.0 ± 0.1°, p < 0.01; -67.3 ± 22.9°/s vs. -122.5 ± 52.8°/s, p< 0.01) and CT group (10.0 ± 0.1°, p < 0.01; -103.3 ± 29.3°/s, p < 0.01). The univariate analysis showed significant correlationbetween E/A ratio and HR (r = -0.54; p < 0.001), LVT (r = -0.45; p < 0.01), UTW (r = 0.24; p < 0.05). At the multivariateanalysis only HR was confirmed as independent predictor of diastolic function in all groups (Beta -0.52; p < 0.001). Conclusion: In ET there was a better global systolic and diastolic functional reserve at rest observed with strain analysis and itmaybe depended on autonomic modulation.

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