Di Gioia Giuseppe, Ferrera Armando, Maestrini Viviana, Monosilio Sara, Mango Federica, Ortolina Davide, Pelliccia Antonio, Squeo Maria Rosaria
Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Rome, Italy.
Am Heart J. 2026 Feb;292:107271. doi: 10.1016/j.ahj.2025.09.003. Epub 2025 Sep 8.
Athlete's heart, characterized by cardiac chambers adaptations to exercise has some diagnostic overlaps with dilated cardiomyopathy (DCM). In the setting of differential diagnosis, myocardial work indexes (MWI), afterload-independent tool, could be helpful to identify early subclinical alterations. The aim of our study was to assess the utility of MWI in athletes with mildly reduced left ventricular ejection fraction (LVEF).
We enrolled 306 Olympic athletes (55.5% males) practicing endurance and mixed disciplines, mean age 26.3 ± 4.3 years old, who underwent cardio-pulmonary exercise test (CPET) and transthoracic echocardiogram. Athletes were divided in those with lower (<55%) and normal LVEF (≥55%). Strain rate and MWI were performed and the following parameters collected: global longitudinal strain, global myocardial work index (GWI), constructive myocardial work (CMW), wasted myocardial work (WMW) and global cardiac work efficiency (GWE).
Twenty-seven athletes had LVEF<55% (mean 51.5% ± 2.6%). Athletes with EF < 55% presented larger LVEDVi (79.1 ± 15.7 vs. 73.2 ± 13.8 mm/m2, P = .035), LV mass (P = .049) and LAVi (P = .016). No differences were found in GWI (1,757.9 ± 242 vs 1,839.8 ± 255.6 mmHg%, P = .112), GCW (2,121.6 ± 269.3 vs. 2,209.3 ± 281 mmHg%, P = .124), GWW (95.2 ± 40.7 vs. 87.1 ± 47.4 mmHg%, P = .394) or GWE (95.2 ± 1.7 vs. 95.7 ± 2%, P = .181). At CPET, in those with EF < 55%, higher Watts (340.0 ± 83.7 vs. 291.6 ± 84.8, P = .004), VO mL/min/Kg (51.0 ± 13.5 vs. 46.0 ± 10.1, P = .020) and O2 pulse (23.5 ± 4.6 vs. 21 ± 5.3, P = .020) were found.
MWI could be used as additive tool to characterize the physiologic nature of mildly reduced EF of endurance athletes, presenting with better functional parameters but preserved MWI values. MWI may be helpful in differential diagnosis of athlete's heart from DCM.
运动员心脏以心腔适应运动为特征，与扩张型心肌病（DCM）存在一些诊断重叠。在鉴别诊断时，心肌做功指数（MWI）作为一种后负荷独立工具，可能有助于识别早期亚临床改变。我们研究的目的是评估MWI在左心室射血分数（LVEF）轻度降低的运动员中的应用价值。
我们纳入了306名从事耐力和混合项目的奥运会运动员（55.5%为男性），平均年龄26.3±4.3岁，这些运动员接受了心肺运动试验（CPET）和经胸超声心动图检查。运动员被分为LVEF较低（<55%）和正常（≥55%）两组。进行应变率和MWI测定，并收集以下参数：整体纵向应变、整体心肌做功指数（GWI）、建设性心肌做功（CMW）、无效心肌做功（WMW）和整体心脏做功效率（GWE）。
27名运动员LVEF<55%（平均51.5%±2.6%）。EF<55%的运动员LVEDVi更大（79.1±15.7 vs. 73.2±13.8 mm/m²，P = 0.035）、左心室质量更大（P = 0.049）和左心房容积指数更大（P = 0.016）。GWI（1,757.9±242 vs 1,839.8±255.6 mmHg%，P = 0.112）、GCW（2,121.6±269.3 vs. 2,209.3±281 mmHg%，P = 0.124）、GWW（95.2±40.7 vs. 87.1±47.4 mmHg%，P = 0.394）或GWE（95.2±1.7 vs. 95.7±2%，P = 0.181）未发现差异。在CPET中，EF<55%的运动员瓦特数更高（340.0±83.7 vs. 291.6±84.8，P = 0.004）、每分每千克摄氧量（VO mL/min/Kg）更高（51.0±13.5 vs. 46.0±10.1，P = 0.020）和氧脉搏更高（23.5±4.6 vs. 21±5.3，P = 0.020）。
MWI可作为一种辅助工具，用于描述耐力运动员EF轻度降低的生理本质，这些运动员具有较好的功能参数但MWI值保持不变。MWI可能有助于运动员心脏与DCM的鉴别诊断。
