Novel insights into the athlete’s heart: is myocardial work the new champion of systolic function?

Abstract

Aims We sought to investigate the correlation between speckle-tracking echocardiography (STE)-derived myocardial work (MW) and invasively measured contractility in a rat model of athlete's heart. We also assessed MW in elite athletes and explored its association with cardiopulmonary exercise test (CPET)-derived aerobic capacity. Methods and results Sixteen rats underwent a 12-week swim training program and were compared to controls (n = 16). STE was performed to assess global longitudinal strain (GLS), which was followed by invasive pressure-volume analysis to measure contractility [slope of end-systolic pressure–volume relationship (ESPVR)]. Global MW index (GMWI) was calculated from GLS curves and left ventricular (LV) pressure recordings. In the human investigations, 20 elite swimmers and 20 healthy sedentary controls were enrolled. GMWI was calculated through the simultaneous evaluation of GLS and non-invasively approximated LV pressure curves at rest. All subjects underwent CPET to determine peak oxygen uptake (VO2/kg). Exercised rats exhibited higher values of GLS, GMWI, and ESPVR than controls (−20.9 ± 1.7 vs. −17.6 ± 1.9%, 2745 ± 280 vs. 2119 ± 272 mmHg·%, 3.72 ± 0.72 vs. 2.61 ± 0.40 mmHg/μL, all PExercise < 0.001). GMWI correlated robustly with ESPVR (r = 0.764, P < 0.001). In humans, regular exercise training was associated with decreased GLS (−17.6 ± 1.5 vs. −18.8 ± 0.9%, PExercise = 0.002) but increased values of GMWI at rest (1899 ± 136 vs. 1755 ± 234 mmHg·%, PExercise = 0.025). GMWI exhibited a positive correlation with VO2/kg (r = 0.527, P < 0.001). Conclusions GMWI precisely reflected LV contractility in a rat model of exercise-induced LV hypertrophy and captured the supernormal systolic performance in human athletes even at rest. Our findings endorse the utilization of MW analysis in the evaluation of the athlete’s heart.

Echocardiographic myocardial work in pre-adolescent male basketball players: a comparison with cardiopulmonary exercise test-derived aerobic capacity

“…Jain et al (Sengupta et al, 2020) performed MW analysis in 24 half-marathon runners: all athletes had increase in LV volume and a mild reduction in peak GLS, associated with a normal value of GWI. While in a study of 20 elite swimmers, Tokodi et al showed that regular exercise training was associated with decreased GLS but increased values of GWI at rest (Tokodi et al, 2021). The inconsistency between the current study and previous research could be explained by the sensitivity of GWI to afterload and thus its wide range of normal values that overlaps with pathological ones (Manganaro et al, 2019).…”

“…A major finding of the current study is that GWI and GWE indexed by body mass correlate with relative VO 2 max in preadolescent athletes. Previous studies in adult athletes have reported the association between either GWI or GWE at rest and relative VO 2 max (Tokodi et al, 2021;D'Andrea et al, 2020). The current study is different in that the GWI and GWE alone did not demonstrate correlation with either VO 2 max or relative VO 2 max but the indexed ones did.…”

“…It has already been tested under several pathological conditions (Chan et al, 2019;El Mahdiui et al, 2019;Hiemstra et al, 2020;Sengupta et al, 2020;Jaglan et al, 2021) and proved feasible in a healthy paediatric population (Pham et al, 2021). Besides, PSL markers also demonstrated a significant correlation with peak oxygen consumption (VO 2 max) in adult athletes and were suggested to be good predictors of the contractile reserve under stress (Tokodi et al, 2021;D'Andrea et al, 2020). The aim of this crosssectional study was to evaluate LV function with PSL analysis in a group of pre-adolescent basketball players during a cardiopulmonary exercise test (CPX) and to explore the relation of these PSL-derived indices to CPX-derived aerobic capacity (both VO 2 max and VO 2 max/kg).…”

Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease

“…This finding of higher GWE in PACR is more evident after 6 months of HT since before 6 months, some degree of ischemic injury might be present in both groups ( 5 ) as a confounding factor for rejection injury. Interestingly, in an elegant study by Tokodi et al ( 20 ), GLS was impaired in elite swimmers, while indices of MW were completely normal, maintaining normal LV function, probably as a consequence of a better description of myocardial contractility. In summary, MW indices mighty precociously differentiate PACR compared to GLS in the first year of HT.…”

“…Nevertheless, GWE is significantly higher in PACR subjects than in NACR subjects, including 1-year HT and borderline HT, if only less than 6 months of HT are included. A possible hypothesis for this finding is that patients with PACR have increased afterload as a consequence of neurohormonal activation ( 3 ) and slightly higher blood pressure; to maintain normal ejection fraction, the contractile efficiency must be compensated ( 20 ). This finding of higher GWE in PACR is more evident after 6 months of HT since before 6 months, some degree of ischemic injury might be present in both groups ( 5 ) as a confounding factor for rejection injury.…”