Supplementary material
METHODS
Characterization of training periods
a) before the competitive period, athletes trained for at least 20 hours/week. Training sessions
consisted of high volume/low intensity running and sprinting conditioning. Athletes also
performed 2-3 resistance-training sessions per week at high-moderate workload.
b) during the competitive period, athletes trained for at least 12 hours/week and played one/two
matches a week. They trained at workloads from 70% to 95% of maximal heart rate, as indicated
by individual heart rate monitoring. Training sessions consisted of technical-tactical drills, low
volume/high intensity running and sprinting conditioning (basketball players) and jumping and
sprinting conditioning (volleyball players). Athletes also performed 1-2 resistance-training sessions
per week at moderate workload.
c) During the last 6 weeks of the season, the running, sprinting and resistance training sessions
were reduced and finally the training program consisted only of technical and tactical drills.
RESULTS
Left ventricular in-seasonal changes
Left ventricular in-seasonal changes are shown in table 1.
Supplementary Table 1. Left ventricular echocardiographic parameters observed during the
agonistic season in competitive athletes.
Variable
Pre-season
Mid-season
End-season
Overall P
value
LV end-diastolic volume, mL
128.7 ± 33.0
137.2 ± 32.7
143.1 ± 36.5*
.033
LV end-systolic volume, mL
53.6 ± 14.6
55.5 ± 12.2
57.4 ± 16.4
.46
LV ejection fraction, %
58.5 ± 0.6
59.1 ± 0.5
60.0 ± 0.5
.24
LVM, g
158.8 ± 57.2
177.9 ± 56.6†
178.5 ± 55.3†
.007
e’/a’ ratio
2.30 ± 0.51
2.55 ± 0.96
2.32 ± 0.69
.55
E/e’ ratio
5.1 ± 0.7
5.2 ± 0.7
4.8 ± 0.4‡
.049
-19.5 ± 2.9
-19.7 ± 2.4
-20.2 ± 2.4
.57
LV longitudinal strain, %
Data are expressed as mean±SD. LV, left ventricular; LVM, left ventricular mass. *p<.05 vs. pre-season; †p<.0005 vs.
pre-season; ‡p <.05 vs. mid-season.
Reproducibility of RV measurements
Strain analysis was feasible in all subjects and none of the participants was excluded because of
poor quality imaging. A significant high consistency (ICC>0.80) was proven for dimensional and
strain repeated measurements (see table 2). Standard error of measurement/mean ratio was <5%,
thus the accuracy was high and random or systematic errors did not affect the outcomes. Changes
measured at mid- and end-season time-points were greater than minimum detectable change in
absolute values, thus the observed variations have to be considered as determined by the effects
of exercise conditioning rather than by statistical variability.
Supplementary Table 2. Relative and absolute reliability of measurements: Intraclass Correlation
Coefficient (ICC3,1), SEM and MDC95%.
r
CI95%low
CI95%up
F14,28
EDDbas
0,9883
0,7065
0,9461
19,5240
EDDmed
0,9636
0,3482
0,8420
RVD area
0,9669
0,3844
RVS area
0,9300
RV strain
0,9502
p
SEM
mean
SEM/mean
MDC95%
8,05E-11
0,6349
39,2444
0,0162
1,7598
6,1788
2,2528E-05
0,8207
31,4667
0,0261
2,2748
0,8554
6,8229
8,85E-06
0,7015
24,5311
0,0286
1,9443
0,0976
0,7181
3,1445
0,00478231
0,5585
13,3936
0,0417
1,5480
0,2279
0,7903
4,4774
3,65E-04
0,9712
-27,5520
-0,0352
2,6919
EDD, end-diastolic diameter; RVD, right ventricular diastolic; RVS, right ventricular systolic.