Myocardial Work Index in Professional Football Players: A Novel Method for Assessment of Cardiac Adaptation

Abstract

Background: The global myocardial work index (GWI), a novel, valid, and non-invasive method based on speckle-tracking echocardiography, could provide value for calculating left ventricular (LV) function and energy consumption in athletes. Materials and Methods: We prospectively analyzed a single-center cohort of Spanish First-Division football players who attended a pre-participation screening program from June 2020 to June 2021, compared to a control group. All the individuals underwent an electrocardiogram and echocardiography, including two-dimensional speckle tracking and 4D-echo. The study aimed to evaluate the feasibility of myocardial work in professional football players and its correlations with other echocardiographic parameters. Results: The study population comprised 97 individuals (49 professional players and 48 controls). The mean age was 30.48 ± 7.20 years old. The professional football players had significantly higher values of LVEDV (p < 0.001), LVESV (p < 0.001), LV-mass index (p = 0.011), PWTd (p = 0.023), and EA (p < 0.001) compared with the control group. In addition, the professional players had lower GCW (p = 0.003) and a tendency to show lower GWI values (p < 0.001). These findings could suggest that professional football players have more remodeling and less MW, related to their adaptation to intensive training. Significant differences in GLS (p = 0.01) and GWE (p = 0.04) were observed as a function of the septal thickness of the athletes. Irrespective of the MW variable, the parameters with better correlations across all the populations were SBP, DBP, and GLS. Conclusions: The GWI is a novel index to assess cardiac performance, with less load dependency than strain measurements. Future GWI analyses are warranted to understand myocardial deformation and other pathological differential diagnoses.

Exercise Stress Echocardiography in Athletes: Applications, Methodology, and Challenges

“…Isometric effort en-hances strain, particularly in the mid-apical LV segments, indicating a greater regional function reserve [48]. As suggested by the recent study of D'Andrea et al [49], a comprehensive strain study, both at rest and during ESE, could play an incremental role in aiding clinicians in managing and making decisions for the endurance of the athletes' hearts. Additionally, the mechanical dispersion of GLS, measured as the standard deviation of the time to peak longitudinal strain across all LV segments, appears to be a promising diagnostic tool for HCM in athletes [50].…”