Myocardial work indices in 662 Olympic athletes were independent of sport discipline, though males had higher wasted work (91.5 vs. 79.7 mmHg%, p=0.0008) and lower efficiency than females.
Observational (n=662)
This study establishes sport-independent, sex-specific reference values and preliminary thresholds for myocardial work indices in elite athletes to aid in differentiating physiologic remodelling from early cardiomyopathy.
INTRODUCTION: Differentiating exercise-induced cardiac remodelling from early dilated cardiomyopathy remains challenging in athletes, as conventional echocardiographic parameters may overlap in cardiomyopathies and physiologic remodelling. Myocardial work indices (MWI) have been proposed as a promising tool to improve characterization of physiologic remodelling and eventually help in this distinction. However, reference values in athletic populations are currently lacking. OBJECTIVES: The aim of this study was to define sex-specific and sport-independent reference values for MWI in a large cohort of Olympic athletes. METHODS: 662 Olympic athletes (51.7% males, mean age 25.5±5.3 years) undergoing standardized pre-participation cardiovascular screening, including comprehensive transthoracic echocardiography with two-dimensional speckle-tracking. Global myocardial work index (GWI), constructive work (GCW), wasted work (GWW), and global work efficiency (GWE) were calculated using non-invasive LV pressure-strain loops. Athletes were categorized into power, skill, endurance, and mixed disciplines. Sex- and discipline-specific comparisons were performed, reference values were derived using the 2.5th-97.5th percentiles, and associations with age were explored. RESULTS: In the overall cohort, mean GWI was 1806.1±250 mmHg%, GCW 2188.9±282 mmHg%, GWW 85.8±42.4 mmHg%, and GWE 95.7±2.0%. GWI and GCW did not differ between males and females, whereas males showed higher GWW (91.5±45.7 vs. 79.7±37.7 mmHg%, p=0.0008) and slightly lower GWE (95.4±2.3 vs. 95.9±1.7%, p=0.0004). No significant differences in MWI were observed across sport disciplines. Segmental analysis revealed sex-related differences mainly in basal and mid-LV segments. Age showed only weak, clinically negligible associations with MWI. Proposed limit thresholds were 1346.7 mmHg% for GWI, 1656.1 mmHg% for GCW, GWW >206.8 mmHg% in males and >174 mmHg% in females, and GWE <91% in males and <92% in females. CONCLUSIONS: In Olympic athletes, myocardial work is largely independent of sport discipline and age, while sex-specific differences are driven by myocardial efficiency and wasted work. This study establishes sport-independent, sex-specific reference values and preliminary thresholds for MWI, observed in a large cohort of elite athletes, that may help in guiding diagnosis when evaluating doubtful cases of cardiac remodelling.
Gioia et al. (Fri,) conducted a observational in Olympic athletes (n=662). Comprehensive transthoracic echocardiography with two-dimensional speckle-tracking vs. Males vs. Females and across sport disciplines was evaluated on Sex-specific and sport-independent reference values for myocardial work indices (GWI, GCW, GWW, GWE). Myocardial work indices in 662 Olympic athletes were independent of sport discipline, though males had higher wasted work (91.5 vs. 79.7 mmHg%, p=0.0008) and lower efficiency than females.