Noninvasive biventricular pressure-strain-volume loop-derived myocardial work analysis in competitive athletes

Area of Science:

• Cardiology
• Exercise Physiology
• Medical Imaging

Background:

• Intense exercise causes hemodynamic load on the heart, leading to well-characterized morphological remodeling.
• Assessing exercise-induced functional changes like enhanced contractility noninvasively is challenging.
• Current methods for evaluating cardiac function in athletes may be influenced by loading conditions.

Purpose of the Study:

• Introduce a novel 3D echocardiography (3DE)-derived method for noninvasive quantification of biventricular systolic function.
• Develop metrics less dependent on loading conditions for competitive athletes.
• Explore the relationship between these novel cardiac function metrics and peak exercise capacity.

Main Methods:

• Enrolled 260 athletes and 24 sedentary volunteers for 3DE analysis.
• Measured left ventricular (LV) and right ventricular (RV) volumes and ejection fractions (EF).
• Derived volume-adjusted myocardial work (MW) indices (LV GWIV and RV GWIV) using pressure-strain-volume loops.

Main Results:

• Athletes exhibited lower biventricular EF and LV global longitudinal strain (GLS) but significantly higher LV GWIV and RV GWIV compared to controls.
• RV GWIV demonstrated the strongest correlation with exercise capacity among functional echocardiographic parameters.
• RV GWIV was identified as an independent predictor of exercise capacity.

Conclusions:

• The novel 3DE-derived metrics effectively capture enhanced biventricular function in athletes at rest.
• Right ventricular myocardial work (RV GWIV) is a robust indicator of enhanced cardiac function in athletes.
• RV GWIV is independently associated with higher peak exercise capacity, offering a valuable clinical metric.