Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

Abstract

Background The health of athletes has been recognized as a worldwide public concern with more reported sudden cardiac deaths (SCD). Therefore, early detection of abnormal heart function in athletes can help reduce the risk of exercise. A novel valid non-invasive method to evaluate left ventricular (LV) myocardial work (MW) using LV pressure-strain loop (PSL), was used in this paper to explore LV systolic function in young male strength athletes. Methods Thirty-six professional young male strength athletes (the athlete group) and 32 healthy, age-matched young men (the control group) were involved in the study. The LVMW parameters were calculated as the area of PSL by two-dimensional speckle tracking echocardiography (2D-STE) and peak systolic LV pressure. The differences between two groups of data and the predictive efficacy of MW parameters for LV systolic function were analyzed. Results The athlete group had significantly higher values of global wasted myocardial work (GWW) and peak strain dispersion (PSD) than did the control group (P<0.05). Global myocardial work index (GWI), global constructive myocardial work (GCW) and global longitudinal strain (GLS) were lower in the athlete group than that in the control group, although statistical significance was not reached (P>0.05). Due to the proportion of GWW and GCW, statistically significant reduction was found in global myocardial work efficiency (GWE) in the athlete group. Conventional echocardiography parameters were well correlated with GWW and GWE (P<0.05). The best predictor of LV myocardial contractile performance in the athletes using receiver operating characteristic curve (ROC) was GWE, with the area under ROC (AUC) of 0.733, sensitivity of 83.3% and specificity of 59.4%. Conclusions Subclinical changes have appeared in the hearts of young male strength athletes after long-term intensive exercise and LVMW parameters by PSL play an important role in the evaluation of athlete’s LV contractile performance.

Myocardial Work: Methodology and Clinical Applications

“…MW has already proven to be more sensitive than EF in detecting LV dysfunction in cases of cardiomyopathy and normal EF [ 22 ] in patients with chronic kidney disease where subclinical dysfunction can be detected [ 23 ]. Similarly, in athletes with normal cardiac function, MW can detect myocardial changes after long-term intensive exercise [ 24 ]. Several patterns for bull’s eye and PSL have been published according to the underlying pathology, showing the difference between normal subjects and patients with hypertension, ischemic, and nonischemic cardiomyopathy [ 25 ] ( Figure 4 and Figure 5 ).…”

Evaluation of Left Ventricular Myocardial Work Quantitatively by Pressure-strain Loop in Young Strength Athletes With Different Heart Rates

“…Dyssynchronous ventricular wall motion, that was impaired synchronization of myocardial contraction evidenced by increased PSD in the two athlete groups resulted in the mechanical efficiency of LV ejection reduced [22]. LV remodeling and decreased synchronization of myocardial contraction could cause electrophysiological abnormalities of myocardium, not only leading to cardiac conduction disturbances but also reducing the effectiveness of myocardial coordination in contraction and relaxation [23,24]. The evidence stated as above were more obvious in athletes with faster heart rates.…”

Evaluation of Left Ventricular Global and Regional Myocardial Work Quantitatively by Pressure-strain Loop in Young Strength Athletes With Different Heart Rates

“…Dyssynchronous ventricular wall motion, that was impaired synchronization of myocardial contraction evidenced by increased PSD in the two athlete groups resulted in the mechanical e ciency of LV ejection reduced [22]. LV remodeling and decreased synchronization of myocardial contraction could cause electrophysiological abnormalities of myocardium, not only leading to cardiac conduction disturbances but also reducing the effectiveness of myocardial coordination in contraction and relaxation [23,24]. The evidence stated as above were more obvious in athletes with faster heart rates.…”