Strain and Myocardial Work Index during Echo Exercise to Evaluate Myocardial Function in Athletes

Abstract

The aim of the study was to evaluate the application of global longitudinal strain (GLS) and myocardial work (MW) at rest and during exercise in healthy sedentary or trained participants, to test their ability to improve echocardiographic information and to complement prescribing exercise, cardiac screening, or rehabilitation programs. Methods: Thirty healthy males were divided into three groups of 10, sedentary (G1), resistance (G2) and power (G3) athletes, underwent a standard clinical evaluation protocol and exercise stress testing echocardiography. Results: During stress, all showed increased left ventricular ejection fraction and mitral annulus tissue Doppler (E'). G1 showed a decrease in left atrial volume (LAVi) as opposed to an increase in G3. E/E 'a decrease in G2, unlike the increase in G3. All groups showed increase of Strain (GLS average AV, Longitudinal LS, Medio-Basal MB Apical AP), global constructive work (GCW), and Global wasted work. G1 showed increase for global work efficiency, G2 and G3 for global work index (GWI). G3 showed a greater variation of E/E', LAVi, GWI and GCW compared to G1 and G2, greater of GLS AV, LS-AP compared to G2. Only G3 showed differences for GLS AV versus LS-AP. The relative regional strain ratio showed a greater value in G3 versus G1 at the end of stress compared to rest. Conclusions: The new echocardiographic applications to study the physiological adaptation could open new perspectives for the diagnostic and therapeutic development through the prescription of personalized exercises and screening and follow-up of the early pathological changes of the athlete's heart.

Left Ventricle Segmental Longitudinal Strain and Regional Myocardial Work Index Could Help Determine Mitral Valve Prolapse Patients with Increased Risk of Ventricular Arrhythmias

“…Therefore, the combination of longitudinal strains with afterload conditions, as is estimated in MW analysis, seems to be more accurate in evaluating the work of the separate segments [16,57]. The physiological remodeling of a healthy heart due to increased afterload during physical activity could be accompanied by increased absolute values of longitudinal strain and MW, which is, however, more homogenous than in MVP patients, and presents only during physical exercise, and does not lead to abnormal stretching [58]. In MVP patients, significantly increased regional longitudinal shortening with increased MW values present permanently, i.e., also at resting conditions, and may result in oxidative stress and possible fibrotic response [57]-a potential substrate for VA.…”

Mitral and Tricuspid Valve Disease in Athletes

“…This discordance may be related to the impact on the diagnostic utility of GLS strain measurements of multiple factors such as preload, afterload, LV geometry, and sinus bradycardia [33,82,83]. However, these limitations could be overcome by measuring GLS in athletes during exercise [84].…”

Effects of different exercise testing methods on left ventricular deformation and its correlation with cardiopulmonary exercise capacity in competitive athletes – semi-recumbent ergometer vs. treadmill testing

“…In contrast to LVEF, GLS and GWI have been shown to be reliable in distinguishing between physiological adaption (e.g., LV hypertrophy due to exercise) and pathological changes (e.g., hypertrophic cardiomyopathy) in the athletes' heart 12,13 .…”