Can Baseline LV-GLS Predict Long-Term Cardiopulmonary Performance in Athletes and Prior SARS-CoV-2 Infection?

Left ventricular global longitudinal strain (LV GLS) is a sensitive echocardiographic marker for detecting subclinical myocardial dysfunction before a decline in LV ejection fraction (EF) occurs. Cross-sectional studies have demonstrated associations between LV GLS and cardiopulmonary performance, particularly peak oxygen uptake (VO_₂peak). However, longitudinal data evaluating on whether baseline LV GLS can predict future changes in VO_₂peak are currently lacking, especially in at-risk populations such as post-COVID-19 patients, cancer survivors, and elite athletes. 

Purpose

The pilot study investigates whether baseline LV GLS predicts longitudinal changes in VO_₂peak among athletes with a history of SARS-CoV-2 infection.

Methods 

In this single-center substudy, elite and recreational athletes from endurance, strength and mixed sports disciplines underwent transthoracic echocardiography, including speckle-tracking strain imaging, and cardiopulmonary exercise testing at baseline (t₁) and after 12 months (t₂). Univariable and multivariable regression analyses were performed to assess the predictive value of baseline LV GLS for changes in VO_2peak. Moderation analyses tested for interaction effects by sex or body mass index (BMI).

Results

A total of 48 post-COVID athletes (25 male; age 34 ± 12 years, VO_2peak 38 ± 11.3 mL/min/kg) were included. Baseline LV GLS significantly predicted VO2_peak after 12 months (β = –2,24, 95 %-CI [–3,84; –0,65], p = 0.007), but after adjusting for sex, age, and BMI, the association was no longer significant, though a trend remained (β = –1,26, 95 %-KI [–2,69; 0,16], p = 0.080). Moderation analysis did not reveal significant interaction effects, suggesting that the predictive value of LV GLS for VO_2peak was consistent across BMI levels and sexes (LV GLS x BMI: β = 0.26, 95 %-CI [–0.21; 0.72], p = 0.276; LV GLS x sex: β = 0.98, 95 %-CI [–2.05; 4.00], p = 0.519).

Conclusion

Baseline LV GLS was associated with VO_₂peak after 12 months, but this relationship was attenuated after adjustment for sex, age, and BMI. No significant interaction effects with BMI or sex were observed, indicating a consistent predictive value of LV GLS across subgroups. These findings suggest a potential prognostic role of LV GLS in athletes recovering from COVID-19, warranting confirmation in larger cohorts.