Pellegrino Alessio, Toncelli Loira, Vanni Simone, Modesti Alessandra, Pedrizzetti Gianni, Modesti Pietro Amedeo
Sport Medicine Unit, Careggi University Hospital, Florence, Italy.
Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
Am J Physiol Heart Circ Physiol. 2025 Mar 1;328(3):H393-H400. doi: 10.1152/ajpheart.00882.2024. Epub 2025 Jan 20.
The study was designed to investigate the pattern of intraventricular hemodynamic forces (HDFs) and myocardial performance during exercise in elite cyclists (ECs). Transthoracic stress echocardiography was performed on 19 ECs and 13 age-matched sedentary controls (SCs) at three incremental exercise intensities based on heart rate reserve (HRR). Left ventricular (LV) HDFs were computed from echocardiography long-axis datasets using a novel technique based on endocardial boundary tracking, both in apex-base and latero-septal directions. Pressure volume (PV) loops were noninvasively investigated using the single-beat approach. Differences between groups were investigated using mixed model analysis. At PV loops, EC showed a steeper increase in stroke work compared with SC, without acute changes in ventricular capacity (EDVI). Contractility, measured as ventricular elastance (E), increased during exercise with no difference between groups ( = 0.625). At rest, EC had significantly lower heart rates and generated lower HDF than SC. However, during exercise, the pressure gradient developed by EC in systole, and therefore systolic HDF, was significantly higher than that developed by SC ( < 0.009), also showing a greater elastic rebound in late systole compared with SC ( < 0.032). Importantly, during early diastolic filling, EC showed lower HDF deceleration than SC ( < 0.043), indicating a facilitated relaxation of the left ventricle. Analysis of the HDF pattern during exercise shows the functional changes that occur in EC, characterized by increased HDF generation in systole, and facilitated relaxation in early diastole. This is the first time LV structural and functional remodeling is reported for elite cyclists during exercise. Analysis of the hemodynamic forces shows that the functional changes that occur in elite cyclists during exercise are characterized by increased hemodynamic forces generation in systole, and facilitated relaxation in early diastole.
本研究旨在调查精英自行车运动员（ECs）运动期间心室内血流动力学力（HDFs）模式及心肌功能。基于心率储备（HRR），在三个递增运动强度下，对19名ECs和13名年龄匹配的久坐对照者（SCs）进行经胸应力超声心动图检查。使用基于心内膜边界追踪的新技术，从超声心动图长轴数据集计算左心室（LV）HDFs，包括心尖 - 心底方向和侧壁 - 间隔方向。采用单搏法对压力 - 容积（PV）环进行无创研究。使用混合模型分析研究组间差异。在PV环方面，与SCs相比，ECs的每搏功增加更为陡峭，心室容量（EDVI）无急性变化。以心室弹性（E）衡量的收缩性在运动期间增加，组间无差异（= 0.625）。静息时，ECs的心率显著较低，产生的HDF比SCs低。然而，运动期间，ECs在收缩期产生的压力梯度以及因此产生的收缩期HDF显著高于SCs（<0.009），与SCs相比，在收缩期末期也表现出更大的弹性反弹（<0.032）。重要的是，在舒张早期充盈期间，ECs的HDF减速低于SCs（<0.043），表明左心室舒张更容易。运动期间HDF模式分析显示了ECs中发生的功能变化，其特征是收缩期HDF产生增加，舒张早期舒张更容易。这是首次报道精英自行车运动员运动期间左心室结构和功能重塑。血流动力学力分析表明，精英自行车运动员运动期间发生的功能变化的特征是收缩期血流动力学力产生增加，舒张早期舒张更容易。
