Patterns of left ventricular remodeling according to the type of sport in a cohort of elite athletes assessed by speckle tracking echocardiography
Authors: Nita B , Beladan C C , Majina N , Burcin A , Popescu B A 
Published: January 2025

Abstract

Background
Athletic training is associated with hemodynamic demands leading to physiological cardiac changes referred to as athlete’s heart. Whilst some studies support the hypothesis with predicted eccentric left ventricular hypertrophy (LVH) from endurance training, data confirming concentric-type effects of resistance training are inconsistent. Also, whether specific geometric adaptations are associated with specific changes of LV myocardial performance is undefined.

Purpose
To assess patterns of LV remodeling in relation to the type of sport, using speckle tracking echocardiography (STE) in a cohort of elite athletes (EA).

Methods
132 EA (23±5 years) referred for resting echocardiography during annual check-up were prospectively enrolled.They were involved in competitive sports for &gt;10 hours/week for over 3 years and had no history of cardiac/non-cardiac disease or sudden cardiac death. A control group of 15 healthy volunteers (25±3 years), either sedentary or engaged in &lt;6 h of non-competitive training/week, was enrolled. An echocardiogram was performed in all subjects. Global myocardial work (MW) indices - work index (GWI), constructive work (GCW), work efficiency (GWE) and wasted work (GWW)- were calculated using a software able to construct a noninvasive LV pressure-strain loop based on STE-derived global longitudinal strain (GLS) and LV pressure from systolic cuff pressure. Analysis was performed by an experienced investigator blinded to the sport history of each subject.

Results
Four subgroups of EA were defined according to the sports disciplines: power (n=27), endurance (n=30), mixed (n=62) and skill (n=13). Mean values of LV volumes, wall thickness and mass were significantly higher in EA compared with controls. Normal LV geometry was present in &gt;50% of EA in each group and &gt;70% of power and skill EA. LVH was more prevalent in endurance (23.3%) and mixed (19.4%) as compared to skill (7.7%) and power (7.4%) EA. Eccentric hypertrophy was found only in endurance and mixed EA (&lt;15% each group). Including age, BSA, gender, sport discipline, duration and intensity of training in binary logistic regression to predict LVH, increasing age was the only significant predictor (p=0.01). Conventional and advanced parameters of LV systolic and diastolic function were within normal range in all subjects. The one-way ANOVA revealed no significant differences between groups of EA and controls regarding mean values of GLS, LV ejection fraction and MW indices. However, among EA, endurance EA exhibited the highest values of GCW(2075±228 mmHg%), GWI(1767±222 mmHg%) and GWE(95.5±1.7%) and lowest GWW(76±35 mmHg%) with statistic significance for GWW(p=0.03) and marginally for GWE(p=0.05).

Conclusion
In our study, the type of sport was not related to the presence of LVH. The most significant LV remodeling was observed in EA, as expected, associated with a resting myocardial work profile characterized by highest values of GWI, GCW and GWE and lowest GWW.
MW parameters and the type of sport