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Speckle tracking evaluation in endurance athletes: the “optimal” myocardial work

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Abstract

To analyze left ventricular myocardial deformation and contractile reserve in endurance athletes at rest and during exercise, and their possible correlations with functional capacity. The athlete’s heart in endurance training is characterized by physiologic eccentric remodeling, with left ventricle adaptation at rest and echocardiographic parameters at low end of normality. Assessment of left ventricle systolic function and contractile reserve has an important role in the decision-making and in differential diagnosis with cardiomyopathies. Standard echo, lung ultrasound, left ventricle 2D speckle-tracking strain and myocardial work were performed at rest and during exercise in endurance athletes and in age- and sex-comparable healthy controls. 350 endurance athletes (male sex 58.5%; 31.6 ± 4.2 years) and 150 healthy controls were enrolled. Left ventricular ejection fraction at baseline was comparable between the two groups. Resting left ventricular global longitudinal strain was reduced in endurance athletes (− 18.4 ± 2.6% vs. − 22.4 ± 3.3% in controls; p < 0.01). Myocardial work efficiency did not show significative difference between the two groups. At peak exertion during exercise stress echocardiography, endurance athletes showed better exercise capacity and peak VO2 consumption (58.6 ± 10.2 ml/kg/min vs 38.6 ± 3.3 ml/kg/min in controls, p < 0.0001), associated with a preserved contractile reserve and augmented pulmonary artery systolic pressure. By multivariable analysis myocardial work efficiency at rest was closely related to maximal watts (p < 0.0001), peak VO2, (p < 0.0001), left ventricular E/eʹ (p < 0.001) and number of B-lines (p < 0.001), all measured at peak effort. Myocardial work efficiency shows less load-dependency than global longitudinal strain. Normal resting values of myocardial work efficiency in endurance athletes suggest a physiological remodeling, associated with a better exercise capacity and preserved contractile reserve during physical effort.

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Abbreviations

2D-STE:

2D speckle tracking echocardiography

3D-STE:

3D speckle tracking echocardiography

BP:

Blood pressure

CMR:

Cardiac magnetic resonance

COV:

Coefficient of variation

CR:

Contractile reserve

CW:

Constructive work

DCM:

Dilated cardiomyopathy

EA:

Endurance athletes

EDV:

End-diastolic volume

ESE:

Exercise stress echocardiography

ESV:

End-systolic volume

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

GWI:

Global work index

HCM:

Hypertrophic cardiomyopathy

IVC:

Inferior vena cava

IVRT:

Isovolumic relaxation time

LAVI:

Left atrial volume index

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVMI:

Left ventricular mass index

MW:

Myocardial work

MWE:

Myocardial work efficiency

MWW:

Myocardial wasted work

PASP:

Pulmonary artery systolic pressure

RAP:

Right atrial pressure

ROC:

Receiver operating characteristic

ROI:

Region of interest

RV:

Right ventricular

RVSP:

Right ventricular systolic pressure

RWT:

Relative wall thickness

TAPSE:

Tricuspid annular plane systolic excursion

TD:

Tissue doppler

TRV:

Tricuspid regurgitant velocity

WW:

Wasted work

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Acknowledgements

D’Andrea A and Galderisi M have conceived and designed of the study; Cameli M and D’ Andrea A have draft the article and revised it critically for important intellectual content; Radmilovic J, Mandoli GE, Santoro C, Bandera F have contributed with the acquisition of data, Carbone A has contributed to the analysis and interpretation of data, Bossone E and D’Ascenzi F. has revised the final version to be submitted.

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Authors and Affiliations

  1. Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, Nocera Inferiore (SA) – University of Campania “Luigi Vanvitelli”, Corso Vittorio Emanuele 121°, 80121, Naples, Italy

    Antonello D’Andrea & Juri Radmilovic

  2. Department of Cardiology, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Andreina Carbone

  3. Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy

    Giulia Elena Mandoli, Flavio D’Ascenzi & Matteo Cameli

  4. Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy

    Ciro Santoro & Maurizio Galderisi

  5. Department of Clinical and Experimental Medicine, University of Palermo, Palermo, Italy

    Vincenzo Evola

  6. Heart Failure Unit, Chair of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Francesco Bandera

  7. Department of Biomedical Health Science, University of Milan, Milan, Italy

    Francesco Bandera

  8. Division of Cardiology, Cardarelli Hospital, Naples, Italy

    Eduardo Bossone

Authors
  1. Antonello D’Andrea
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  2. Juri Radmilovic
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  3. Andreina Carbone
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  4. Giulia Elena Mandoli
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  5. Ciro Santoro
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  6. Vincenzo Evola
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  7. Francesco Bandera
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  8. Flavio D’Ascenzi
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  9. Eduardo Bossone
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  10. Maurizio Galderisi
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  11. Matteo Cameli
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Consortia

the Echocardiography Study Group of the Italian Society of Cardiology

Corresponding author

Correspondence to Antonello D’Andrea.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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D’Andrea, A., Radmilovic, J., Carbone, A. et al. Speckle tracking evaluation in endurance athletes: the “optimal” myocardial work. Int J Cardiovasc Imaging 36, 1679–1688 (2020). https://doi.org/10.1007/s10554-020-01871-z

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  • DOI: https://doi.org/10.1007/s10554-020-01871-z

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