Global Longitudinal Active Strain Energy Density (GLASED): Age and Sex Differences in young and Veteran Athletes

Abstract Figure Graphic abstract Clinical perspective Global longitudinal active strain energy density (GLASED) is a recently introduced potential measure of ventricular function that combines myocardial stress and strain information. GLASED estimates the work performed per unit volume of myocardium during contraction. Recent studies with cardiac MRI have demonstrated that GLASED predicts prognosis more accurately than ejection fraction or strain alone. Our current study uses echocardiography and reveals previously unknown physiological differences in myocardial function between male and female athletes, as well as among young and veteran athletes. Our results suggest that GLASED could be a valuable tool in assessing cardiac diseases, particularly when the clinical phenotype is uncertain Background Global longitudinal active strain energy density (GLASED) is an innovative method for assessing myocardial function by quantifying the work performed by the left ventricular muscle. The use of GLASED holds promise for improving the diagnosis and management of cardiac diseases. This study aimed to evaluate the feasibility of measuring GLASED using echocardiography and investigate potential differences in GLASED values among athletes based on age and sex. Methods and Results An observational echocardiographic study was conducted, involving male controls, male and female young athletes, and male and female veteran athletes. GLASED was calculated from the myocardial stress and strain. The mean age (years) of young athletes was 21.6 for males and 21.4 for females, while the mean age of veteran athletes was 53.5 for males and 54.2 for females. GLASED was found to be highest in young male athletes (2.40 kJ/m 3 ) and lowest in female veterans (1.96 kJ/m 3 ). Veteran males exhibited lower values (1.96 kJ/m3) compared to young male athletes (P<0.001). Young females demonstrated greater GLASED (2.28 kJ/m 3 ) than veteran females (P<0.01). However, no significant difference in GLASED was observed between male and female veterans. Conclusions Our findings demonstrate the feasibility of measuring GLASED using echocardiography. GLASED values were higher in young male athletes compared to female athletes, and it decreased with age. Importantly, the sex-related differences observed in GLASED values among young athletes were no longer present in veteran athletes. Estimating GLASED may serve as a valuable screening tool for cardiac diseases in athletes, particularly for those with borderline phenotypes of hypertrophic and dilated cardiomyopathies.