Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2026
Myocardial Work Indices in Olympic Athletes: Sex-Specific Reference Values and the Impact of Sports Disciplines.
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Di Gioia Giuseppe, Ferrera Armando, Ortolina Davide, Spera Francesco Raffaele, Maestrini Viviana, Mango Federica, Ginelli Daniele, Paoletti Giulia, Monosilio Sara, Squeo Maria Rosaria, Pelliccia Antonio
Аннотация
INTRODUCTION: Differentiating exercise-induced cardiac remodeling from early dilated cardiomyopathy remains challenging in athletes, as conventional echocardiographic parameters may overlap in cardiomyopathies and physiologic remodeling. Myocardial work indices (MWIs) have been proposed as a promising tool to improve characterization of physiologic remodeling 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 MWIs in a large cohort of Olympic athletes.
METHODS: Six hundred sixty-two Olympic athletes (51.7% male, mean age 25.5 ± 5.3 years) underwent standardized preparticipation cardiovascular screening, including comprehensive transthoracic echocardiography with two-dimensional speckle-tracking. Global myocardial work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were calculated using noninvasive left ventricular 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 to 97.5th percentiles, and associations with age were explored.
RESULTS: In the overall cohort, mean GWI was 1,806.1 ± 250 mm Hg%, GCW 2,188.9 ± 282 mm Hg%, GWW 85.8 ± 42.4 mm Hg%, and GWE 95.7% ± 2.0%. Global myocardial work index and GCW did not differ between male and female patients, whereas male patients showed higher GWW (91.5 ± 45.7 vs 79.7 ± 37.7 mm Hg%, P = .0008) an d slightly lower GWE (95.4% ± 2.3% vs 95.9% ± 1.7%, P = .0004). No significant differences in MWI were observed across sport disciplines. Segmental analysis revealed sex-related differences mainly in basal and mid-left ventricular segments. Age showed only weak, clinically negligible associations with MWI. Proposed limit thresholds were 1,346.7 mm Hg% for GWI, 1,656.1 mm Hg% for GCW, GWW >206.8 mm Hg% in male patients and >174 mm Hg% in female patients, and GWE <91% in male patients and <92% in female patients.
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 remodeling.
OBJECTIVES: The aim of this study was to define sex-specific and sport-independent reference values for MWIs in a large cohort of Olympic athletes.
METHODS: Six hundred sixty-two Olympic athletes (51.7% male, mean age 25.5 ± 5.3 years) underwent standardized preparticipation cardiovascular screening, including comprehensive transthoracic echocardiography with two-dimensional speckle-tracking. Global myocardial work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were calculated using noninvasive left ventricular 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 to 97.5th percentiles, and associations with age were explored.
RESULTS: In the overall cohort, mean GWI was 1,806.1 ± 250 mm Hg%, GCW 2,188.9 ± 282 mm Hg%, GWW 85.8 ± 42.4 mm Hg%, and GWE 95.7% ± 2.0%. Global myocardial work index and GCW did not differ between male and female patients, whereas male patients showed higher GWW (91.5 ± 45.7 vs 79.7 ± 37.7 mm Hg%, P = .0008) an d slightly lower GWE (95.4% ± 2.3% vs 95.9% ± 1.7%, P = .0004). No significant differences in MWI were observed across sport disciplines. Segmental analysis revealed sex-related differences mainly in basal and mid-left ventricular segments. Age showed only weak, clinically negligible associations with MWI. Proposed limit thresholds were 1,346.7 mm Hg% for GWI, 1,656.1 mm Hg% for GCW, GWW >206.8 mm Hg% in male patients and >174 mm Hg% in female patients, and GWE <91% in male patients and <92% in female patients.
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 remodeling.