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Related Experiment Video

Updated: Sep 23, 2025

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents
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Global longitudinal strain differentiates physiological hypertrophy from maladaptive remodeling.

Yvonne Bewarder1, Lucas Lauder1, Saarraaken Kulenthiran1

  • 1Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.

International Journal of Cardiology. Heart & Vasculature
|May 16, 2022
PubMed
Summary

Global longitudinal strain (GLS) and E/e' are reliable echocardiographic measures to differentiate physiological hypertrophy in athletes from pathological hypertrophy in heart disease, unlike left ventricular mass or ejection fraction.

Keywords:
Adaptive and maladaptive remodelingAthletes’ heartsE/e′EchocardiographyHypertrophic cardiomyopathyLeft ventricular hypertrophyLongitudinal strain

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Area of Science:

  • Cardiology
  • Echocardiography
  • Sports Cardiology

Background:

  • Differentiating physiological left ventricular (LV) hypertrophy in athletes from pathological LV hypertrophy in heart disease is clinically challenging.
  • Standard echocardiographic parameters like LV mass and ejection fraction may not suffice for this distinction.

Purpose of the Study:

  • To evaluate the utility of advanced echocardiographic parameters, specifically E/e' and global longitudinal strain (GLS), in distinguishing physiological hypertrophy from pathological hypertrophy.
  • To compare these parameters in athletes, patients with various heart diseases, and healthy controls.

Main Methods:

  • Compared 78 professional athletes (cyclists, soccer, handball players) with 88 patients exhibiting pathological LV hypertrophy (HOCM, HHD, AVS) and 37 healthy sedentary controls.
  • All participants maintained an LV ejection fraction (LVEF) ≥50%.

Main Results:

  • LV mass index and septal wall thickness were elevated in athletes and pathological hypertrophy groups compared to controls (p < 0.001).
  • E/e' was elevated in pathological hypertrophy but normal in athletes and controls (p < 0.001).
  • GLS was reduced in pathological hypertrophy compared to athletes and controls (p < 0.001). GLS (≥-18%) showed 79% specificity in distinguishing hypertrophy types when septal thickness >11 mm.

Conclusions:

  • Global longitudinal strain (GLS) and E/e' are superior to LV mass and LVEF for differentiating pathological from physiological LV hypertrophy.
  • These advanced echocardiographic measures offer reliable assessment in distinguishing athlete's heart from cardiac disease.