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. 2023 Jun;39(6):1123-1131.
doi: 10.1007/s10554-023-02820-2. Epub 2023 Mar 4.

The impact of upright posture on left ventricular deformation in athletes

J Kandels #  1 , M Metze #  2 , A Hagendorff  2 , R P Marshall  3   4 , P Hepp  5 , U Laufs  2 , S Stöbe  2
Affiliations

The impact of upright posture on left ventricular deformation in athletes

J Kandels et al. Int J Cardiovasc Imaging. 2023 Jun.

Abstract

Besides LV ejection fraction (LVEF), global longitudinal strain (GLS) and global myocardial work index (GWI) are increasingly important for the echocardiographic assessment of left ventricular (LV) function in athletes. Since exercise testing is frequently performed on a treadmill, we investigated the impact of upright posture on GLS and GWI. In 50 male athletes (mean age 25.7 ± 7.3 years) transthoracic echocardiography (TTE) and simultaneous blood pressure measurements were performed in upright and left lateral position. LVEF (59.7 ± 5.3% vs. 61.1 ± 5.5%; P = 0.197) was not affected by athletes' position, whereas GLS (- 11.9 ± 2.3% vs. - 18.1 ± 2.1%; P < 0.001) and GWI (1284 ± 283 mmHg% vs. 1882 ± 247 mmHg%; P < 0.001) were lower in upright posture. Longitudinal strain was most frequently reduced in upright posture in the mid-basal inferior, and/or posterolateral segments. Upright posture has a significant impact on LV deformation with lower GLS, GWI and regional LV strain in upright position. These findings need to be considered when performing echocardiography in athletes.

Keywords: Athletes; Deformation; Echocardiography; Longitudinal strain; Upright posture; Work index.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The diagnostic algorithm. TTE Transthoracic echocardiography
Fig. 2
Fig. 2
Global longitudinal strain measured by 2D echocardiography in upright (A-C) and left lateral position in the same athlete (D-F). Apical long axis, 2- and 4-chamber view (A1-A3, D1-D3) with anatomical M-Mode in the apical long axis view (B1-B2, E1-E2). Strain curves of all three apical views (C1-C3, F1-F3) with the corresponding bull’s eye (C4, F4). The yellow arrow indicates changes in left ventricular wall motion in comparison to left lateral position. AVO Aortic valve opening, AVC Aortic valve closing, MVO Mitral valve opening, MVC Mitral valve closing
Fig. 3
Fig. 3
Assessment of global myocardial work index in upright (A) and left lateral position (B). Bull’s eye of global myocardial work index (A1, B1) with the pressure-strain-loop of the mid-lateral segment of the left ventricle (A2, B2). Comparison of constructive and wasted work in the mid-lateral segment of the left ventricle (A3, B3)
See this image and copyright information in PMC

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