PhD Scientific Days 2026

Poster Session 2.Q - Cardiovascular Medicine and Research

Noninvasive biventricular pressure-strain-volume loop-derived myocardial work analysis in competitive athletes

Name of the presenter

Ferencz, Andrea

Institute/workplace of the presenter

Semmelweis University, Heart and Vascular Center, Budapest, Hungary

Authors

Andrea Ferencz¹, Ádám Szijártó¹, Tímea Katalin Turschl¹, Zsuzsanna Ladányi¹, Bálint Károly Lakatos¹, Márton Tokodi¹, Máté Tolvaj¹, Márk Zámodics¹, Máté Babity¹, Regina Benkő¹, Orsolya Kiss¹, Emese Csulak¹, Nóra Sydó¹, Csongor Meskó¹, Hajnalka Vágó¹, Béla Merkely¹, Attila Kovács¹, Alexandra Fábián¹
1: Semmelweis University, Heart and Vascular Center, Budapest, Hungary

Text of the abstract

Intense exercise imposes an increased hemodynamic load on the heart, inducing structural and functional adaptations that support the increased circulatory demands during physical activity. While morphological remodeling is well-characterized, assessing exercise-induced functional changes, such as enhanced ventricular contractility, remains challenging.
We aimed to introduce a novel 3D echocardiography (3DE)-derived method for noninvasive quantification of biventricular systolic function, less dependent on preload and afterload, in a large cohort of competitive athletes, and to explore the relationship with peak exercise capacity.
We enrolled 260 competitive athletes and 24 healthy, age- and sex-matched sedentary volunteers. Under resting conditions, all subjects underwent 3DE to measure left (LV) and right ventricular (RV) volumes and ejection fractions (EF). Biventricular global longitudinal strain (GLS) tracings and noninvasively estimated pressure curves were concatenated and further adjusted to instantaneous volumes to create pressure-strain-volume loops and derive volume-adjusted myocardial work (MW) indices (LV GWIV and RV GWIV).
Athletes had lower LV EF (athletes vs. controls, 56.5±4.2 vs. 59.9±4.6%; p<0.001) and RV EF (55.1±4.7 vs. 59.9±4.7%; p<0.001), however, significantly higher values of volume-adjusted LV GWIV (10274±2930 vs. 7387±2050 mmHg%·mL, p<0.001) and RV GWIV (3423±1339 vs. 2437±796 mmHg%·mL, p<0.001). Among systolic functional metrics, LV EF (r=-0.20, p<0.001) correlated inversely, whereas LV GLS (r=0.27, p<0.001) and LV GWIV correlated directly (r=0.15, p<0.05) with CPET-derived VO2/kg. In the RV, interestingly, RV GWIV showed a stronger correlation with VO2/kg (r=0.30, p<0.001) than RV EF (r=-0.23, p<0.001). Using multivariable linear regression analysis, RV GWIV was found to be an independent predictor of CPET-derived VO2/kg.
Our noninvasive myocardial work metrics were able to reflect the enhanced LV and RV systolic functions in athletes, even during resting conditions. Moreover, increased RV volume-adjusted myocardial work was independently associated with better CPET-derived peak exercise capacity.
Supported by the 2025-2.1.1-EKÖP-2025-00014 University Research Scholarship Programme of the Ministry for Culture and Innovation of Hungary from the source of the National Research, Development and Innovation Fund.