PhD Scientific Days 2024

Poster Session N - Cardiovascular Medicine and Research 2.

Pressure-strain-volume loop-derived myocardial work for the noninvasive assessment of increased right ventricular contractility in elite athletes

Text of the abstract

Background: Regular, intense exercise results in increased right ventricular (RV) contractility, however, conventional resting echocardiographic metrics cannot capture intrinsic contractile state accurately. Thus, we aimed to develop a novel method to quantify RV function independently of hemodynamic loading conditions and to assess its relationship with exercise capacity in elite athletes.

Methods: Elite athletes (n=269) and sedentary volunteers (n=26) were enrolled and underwent 3D echocardiography (3DE) to measure RV volumes and ejection fraction (EF). 3DE-derived global longitudinal strain (GLS) tracings and non-invasively estimated RV pressure curves were concatenated to calculate global myocardial work index (GMWI). Then, GMWI was adjusted to instantaneous RV volumes (GMWIV), and pressure-strain-volume loops were plotted.

Results: Athletes had lower resting RV EF (55±5 vs. 60±5%; p<0.01), and GLS (-22±3 vs. -23±4%, p<0.05), whereas GMWI did not differ. Athletes had higher values of GMWIV (3436±1360 vs. 2375±813 mmHg%·mL, p<0.01). GMWIV correlated better with cardiopulmonary exercise testing-derived peak oxygen uptake (r=0.57, p<0.01), than RV EF (r=-0.39, p<0.01) and GLS (r=0.25, p<0.01), whereas GMWI did not correlate.

Conclusion: By integrating RV volume into the pressure-strain relationship, our novel metric could adequately reflect enhanced RV function in athletes even during resting conditions. Moreover, our metric showed good correlation with exercise capacity.

Funding: The project was supported by the ÚNKP-23-4-II-SE-37 New National Excellence Program of the Ministry for Innovation and Technology.