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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 LV & RV myocardial 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 type of sport participation & long-term training on parameters of LV & RV systolic & diastolic function including newer modalities of tissue Doppler and myocardial 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 to evaluate LV & RV systolic and diastolic function in 147 elite high school athletes compared to healthy controls. Longitudinal 2D strain was performed to evaluate 17 regional (apical, mid, and basal) myocardial segments as well as RV longitudinal strain at the lateral basal, mid and apical segments. The impact of the type of sport and training (figure skating, ice hockey, soccer) on LV & RV systolic and diastolic function were assessed.Results: Heart rate, LV dimensions, and LV mass were significantly different in athletes compared to healthy controls (p<0.001). Traditional measures of LV and RV systolic and diastolic function as well as tissue Doppler and global longitudinal 2D strain were not different between groups. However, regional differences in LV strain were identified, with apical deformation increased relative to basal function in athletes compared to controls (p<0.001). Increased right ventricular contractility was demonstrated with intense training with tricuspid annular plane systolic excursion (TAPSE) and isovolumic acceleration (IVA) significantly increased in athletes (p<0.001). The most marked differences in these parameters were found in hockey and soccer players.Conclusions: While global LV & RV longitudinal myocardial velocity and deformation were not significantly different in athletes compared to healthy controls, regionally increased LV apical deformation compared to basal function was consistently demonstrated in all athletic groups. Increases in RV measures of contractility including IVA and TAPSE demonstrated augmented RV performance in high school athletes who undergo high intensity long-term athletic training. Whether these changes in myocardial deformation, excursion, and acceleration represent compensatory adaptation, improved cardiopulmonary interaction, or augmented contractile reserve with training deserve further ongoing serial evaluation.