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Introduction: Elite athletes may develop physiologic left ventricular remodeling described as the athlete's heart. In this population, diastolic dysfunction and dyssynchrony might be present as an early marker of pathological remodeling reflecting increased risk of sudden cardiac death.Objective: The aim of our study was to evaluate diastolic function, systolic and diastolic dyssynchrony differentiating physiologic vs. pathologic remodeling in elite athletes compared with hypertrophic (HCM) and dilated (DCM) cardiomyopathy patients.Methods: 57 endurance-strength elite athletes (A), 20 sedentary controls (S), 12 HCM, and 12 DCM patients underwent an echocardiographic study. Diastolic function was evaluated by measuring transmitral flow velocities and diastolic tissue velocities with color coded tissue Doppler imaging (TDI). Systolic and diastolic dyssynchrony was measured, defined as the maximum delay of systolic and diastolic onset in the six basal segments of the left ventricle.Results: Transmitral E/A parameter and E wave deceleration time (EDT) did not differ significantly in athletes, controls or HCM patients (E/A: A 1,67±0,41 vs. S 1,41±0,32 vs. HCM 1,54±0,5; p=0,695; EDT: A 181±36,5 vs. S 175,6±32 vs. HCM 195±32,6ms; p=0,252). The early diastolic tissue velocity was significantly lower in HCM patients (A 7,87±1,53 vs. HCM 4,83±1,68cm/sec; p<0,001), while normal in athletes. In DCM patients, the transmitral flow parameters (E/A: A 1,67±0,41 vs. DCM 1,1±0,5; p<0,001, EDT: A 181±36,5 vs. DCM 134,5±36,7ms; p<0,001) and the early diastolic tissue velocity (A 7,87±1,53 vs. DCM 3,1±1cm/sec; p<0,001) were altered. There was no systolic or diastolic dyssynchrony found in athletes, controls or HCM patients. DCM patients showed significant mechanical dyssnchrony (systolic A 32,5±15,1, S 30±19,5, HCM 33,2±25, DCM 83,8±45,1ms; p<0,001; diastolic A 58±36,3 S 58,3±42,8; HCM 60,5±23, DCM 185±110ms; p<0,001).Conclusions: In elite athletes, we did not find altered diastolic function or systolic and diastolic dyssynchrony of the left ventricle. Hypertrophic and dilated cardiomyopathy patients showed diastolic dysfunction or systolic and diastolic dyssynchrony reflecting pathologic remodeling. Our study points out possible role of echocardiography in the detection of pathologic remodelling in elite athletes.