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Background: Cardiac adaptation to high intensity athletic training is characterized by increases in left ventricular (LV) chamber dimension, wall thickness & mass. The physiologic impact of training on myocardial synchrony & deformation in highly trained elite high school athletes has not been extensively reported. The purpose of this study was to assess the impact of the long-term training on regional & global LV myocardial synchrony & deformation in highly trained high school athletes compared to sedentary controls.Methods: Standard 2D, Doppler, & tissue Doppler were prospectively performed utilizing a GE Vivid 7 system in 50 elite high school athletes compared to healthy controls. Longitudinal synchrony was assessed utilizing color tissue Doppler from basal & mid-levels in the apical 4-chamber, 2-chamber, & long-axis views for a total of 12 sites. Myocardial synchrony was assessed by comparing the 12-site standard deviation in time from QRS onset to peak systolic velocities in athletes versus sedentary controls. In addition, the maximum difference in time-to-peak systolic velocity between any 2 of the 12 sites was also assessed. Longitudinal 2D strain was performed to evaluate 17 regional (apical, mid, & basal myocardial segments) & global longitudinal LV myocardial strain.Results: Heart rate, LV dimensions, & LV mass were significantly different in athletes compared to controls (p<0.001). Traditional measures of LV systolic & diastolic function as well as tissue Doppler & global longitudinal 2D strain were not different between groups. However, global myocardial LV synchrony was enhanced in athletes compared to controls (12-site standard deviation = 27 +/- 6 msec vs 34 +/- 8 msec, p<0.01). Maximal time to peak systolic velocity was also shorter in athletes compared to controls (66 +/- 20 msec vs 76 +/- 19 msec, p<0.01). Regional differences in myocardial deformation were also identified, with apical deformation increased relative to basal function in athletes compared to controls (p<0.001).Conclusions: While global longitudinal myocardial velocity & deformation were not significantly different in athletes compared to healthy controls, regionally increased apical deformation compared to basal function was consistently demonstrated in elite athletes. Myocardial synchrony was enhanced in these athletes as well. Ongoing serial assessment of radial & circumferential deformation as well as LV torsion may add novel insights into whether these differences in electrical and mechanical function represent compensatory adaptations or augmented contractile reserve with training in athletes.