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Speckle tracking evaluation in endurance athletes: the “optimal” myocardial work

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To analyze left ventricular myocardial deformation and contractile reserve in endurance athletes at rest and during exercise, and their possible correlations with functional capacity. The athlete’s heart in endurance training is characterized by physiologic eccentric remodeling, with left ventricle adaptation at rest and echocardiographic parameters at low end of normality. Assessment of left ventricle systolic function and contractile reserve has an important role in the decision-making and in differential diagnosis with cardiomyopathies. Standard echo, lung ultrasound, left ventricle 2D speckle-tracking strain and myocardial work were performed at rest and during exercise in endurance athletes and in age- and sex-comparable healthy controls. 350 endurance athletes (male sex 58.5%; 31.6 ± 4.2 years) and 150 healthy controls were enrolled. Left ventricular ejection fraction at baseline was comparable between the two groups. Resting left ventricular global longitudinal strain was reduced in endurance athletes (− 18.4 ± 2.6% vs. − 22.4 ± 3.3% in controls; p < 0.01). Myocardial work efficiency did not show significative difference between the two groups. At peak exertion during exercise stress echocardiography, endurance athletes showed better exercise capacity and peak VO2 consumption (58.6 ± 10.2 ml/kg/min vs 38.6 ± 3.3 ml/kg/min in controls, p < 0.0001), associated with a preserved contractile reserve and augmented pulmonary artery systolic pressure. By multivariable analysis myocardial work efficiency at rest was closely related to maximal watts (p < 0.0001), peak VO2, (p < 0.0001), left ventricular E/eʹ (p < 0.001) and number of B-lines (p < 0.001), all measured at peak effort. Myocardial work efficiency shows less load-dependency than global longitudinal strain. Normal resting values of myocardial work efficiency in endurance athletes suggest a physiological remodeling, associated with a better exercise capacity and preserved contractile reserve during physical effort.

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2D speckle tracking echocardiography


3D speckle tracking echocardiography


Blood pressure


Cardiac magnetic resonance


Coefficient of variation


Contractile reserve


Constructive work


Dilated cardiomyopathy


Endurance athletes


End-diastolic volume


Exercise stress echocardiography


End-systolic volume


Global circumferential strain


Global longitudinal strain


Global radial strain


Global work index


Hypertrophic cardiomyopathy


Inferior vena cava


Isovolumic relaxation time


Left atrial volume index


Left ventricular


Left ventricular ejection fraction


Left ventricular mass index


Myocardial work


Myocardial work efficiency


Myocardial wasted work


Pulmonary artery systolic pressure


Right atrial pressure


Receiver operating characteristic


Region of interest


Right ventricular


Right ventricular systolic pressure


Relative wall thickness


Tricuspid annular plane systolic excursion


Tissue doppler


Tricuspid regurgitant velocity


Wasted work


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D’Andrea A and Galderisi M have conceived and designed of the study; Cameli M and D’ Andrea A have draft the article and revised it critically for important intellectual content; Radmilovic J, Mandoli GE, Santoro C, Bandera F have contributed with the acquisition of data, Carbone A has contributed to the analysis and interpretation of data, Bossone E and D’Ascenzi F. has revised the final version to be submitted.

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Correspondence to Antonello D’Andrea.

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D’Andrea, A., Radmilovic, J., Carbone, A. et al. Speckle tracking evaluation in endurance athletes: the “optimal” myocardial work. Int J Cardiovasc Imaging 36, 1679–1688 (2020).

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