https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum des Saarlandes Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar, Deutschland
Background:
Differentiation between physiological cardiac remodelling and cardiomyopathy can be challenging in elite athletes. Echocardiographic strain analysis has emerged as a helping tool and has become part of routine cardiac care. In addition to left ventricular strain, which has shown to provide long-term prognostic information in cardio-oncology, right ventricular strain and atrial strain analysis are emerging as potentially relevant biomarkers. To this date, reference ranges on RV, LA and RA strain for elite endurance athletes are unknown.
Methods:
Transthoracic echocardiographic examinations were performed in 112 elite male professional cyclists, including Grand Tour winners and Olympic medallists, as part of their routing care using a portable ultrasound device (GE Vivid iq, M5Sc probe) following current guidelines. They were exercising six times per week for a total of 15 to 25 hours. All athletes had no history of cardiovascular disease. Longitudinal strain was derived with EchoPAC (GE, v204), a vendor-specific software, in all four chambers. The results were compared to previously published reference values of young males of similar age.
Results:
The median left ventricular average global longitudinal strain (LV aGLS) was –21.7% (–24.9 to –18.5), the median right ventricular free wall strain (RV FWS) was –26.2% (–32.3 to –20.1). Compared to our reference population, LV aGLS was slightly but statistically significantly higher, whereas the RV FWS was not different. Left atrial reservoir strain (LASr), conduit strain (LAScd) and contractile strain (LASct) were 49.4% (31-67.8), –34.8 (–49.4 to –20.2) and –14.7 (–25.6 to –3.8), respectively. Right atrial reservoir strain (RASr), conduit strain (RAScd) and contractile strain (RASct) were 46.7% (26.6-66.8), –32.8% (–50.1 to –15.5) and –14% (–24.3 to –3.7), respectively. Compared to our reference population, both left and right atrial reservoir and conduit strain were significantly higher, whereas contractile strain was not significantly different. There was no association between left ventricular enddiastolic diameter, left ventricular mass or enddiastolic volume and longitudinal strain parameters.
Conclusion:
Reference ranges for strain for all cardiac chambers for elite male endurance athletes without history of cardiovascular disease were established. The strain parameters were found to be independent of the extent of cardiac remodelling in healthy young athletes.