Echocardiographic morpho-functional parameters predictors of maximal oxygen uptake and oxygen pulse in a large cohort...

Exercise training induces structural cardiac adaptations, commonly referred to as the athlete's heart. These morphological changes are considered favorable for supporting enhanced cardiac function during effort. However, there are limited data directly correlating structural remodeling parameters with functional indices of cardiovascular performance, such as peak oxygen uptake (VO₂max) and oxygen pulse (O₂ pulse).

We enrolled 1033 Olympic-level athletes (46.8% female; mean age 25.6 ± 5.2 years) across 42 sporting disciplines Athletes underwent pre-participation evaluation including transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET). Echocardiographic parameters of ventricular and atrial size, mass, and function were assessed. Multivariate linear regression analyses were performed to identify independent predictors of VO₂ max and O₂ pulse.

Athletes showed preserved systolic and diastolic function with clear evidence of structural remodeling from skill to endurance sports. At multivariate analysis, LVMi (p < 0.0001, β = 0.19) was independently and positively associated with VO₂ max while E/e' ratio (p = 0.014, β = -0.675) showed significant negative correlation. In the multivariable model for O₂ pulse, female sex (p < 0.0001, β = -3.136) and E/e' ratio (p = 0.027, β = -0.229) were for once negative correlate. Among cardiac parameters, LVMi (p < 0.0001, β = 0.055), LAVi (p < 0.0001, β = 0.131), RVEDA (p < 0.0001, β = 0.236) and TAPSE (p = 0.021, β = 0.122) contributed significantly, while EF showed no significant independent association.

In a large cohort of elite athletes, structural cardiac remodeling parameters were independently correlated with VO₂max and O₂ pulse, indicating that morphological adaptation translates into functional performance.