PhD Scientific Days 2024

Budapest, 9-10 July 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


Alexandra Fábián1, Adam Szijarto1, Adrienn Ujvari1, Bálint K. Lakatos1, Marton Tokodi1, Zsuzsanna Ladányi1, Andrea Ferencz1, Mate Tolvaj1, Kai Shiida1, Orsolya Kiss1, Nóra Sydó1, Hajnalka Vágó1, Prof. Béla Merkely1, Attila Kovacs1
1: Semmelweis University Heart and Vascular Center

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.