Key result
Elite male cyclists exhibit higher LV aGLS versus healthy controls independent of hypertrophy.
Why the study?
Differentiating physiological from pathological cardiac remodelling is challenging in elite athletes, and data on RV, LA, and RA strain are sparse in this population.
How do atrial and ventricular longitudinal strain parameters in elite cyclists compare to healthy references?
Cross-Sectional (n=112)
No
How do atrial and ventricular longitudinal strain parameters in elite cyclists compare to healthy references?
Absolute Event Rate: -21.7% vs -19.8%
p-value: p=<0.0001
Elite cyclists exhibit higher left ventricular and atrial reservoir/conduit strain compared to healthy references, independent of chamber size, suggesting physiological adaptation.
Supports physiological LV adaptation in elite cyclists; hypothesis-generating for athlete-specific strain norms, requiring prospective validation before practice change.
Aims In elite athletes, differentiation between physiological and pathological cardiac remodelling can be challenging. Left ventricular (LV) strain has become part of the standard in echocardiography. Data on right ventricular (RV), left atrial (LA) and right atrial (RA) strain are sparse in elite athletes. Methods Transthoracic echocardiography including longitudinal strain analysis of all cardiac chambers was performed using a GE Vivid iq in 112 male elite professional cyclists aged 24–32 years. All athletes were actively participating in top level international races and included race champions and Olympic medallists. The results were compared to published reference values of healthy males of similar age. Results LV average global longitudinal strain (LV aGLS) was –21.7% (–24.9 to –18.5), significantly higher ( p < 0.0001) than the reference. RV free wall strain (RV FWS) was –26.2% (–32.3 to –20.1), and not different ( p = 0.36) from the reference. Compared to the reference, LA reservoir strain (LASr), LA conduit strain (LAScd), RA reservoir strain (RASr) and RA conduit strain (RAScd) were higher (all p < 0.0001), whereas LA and RA contractile strain (LASct and RASct) were not (both p = 0.2). Strain values were independent of respective chamber sizes. There was an inverse association between the left ventricular mass index and LASr ( p = 0.010) and LAScd ( p = 0.042). Conclusion Strain parameters are independent of the extent of hypertrophy in elite cyclists. An underlying myocardial disease may be suspected in case of lower-than-expected longitudinal strain of any chamber.
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Lagendijk et al. (2026) conducted a cross-sectional in Athlete's heart (n=112). Elite endurance cycling vs. Healthy untrained males of similar age (published reference values) was evaluated on Left ventricular average global longitudinal strain (LV aGLS) (p=<0.0001). Elite male cyclists exhibited significantly higher left ventricular average global longitudinal strain (-21.7%) compared to healthy reference values (-19.8%), independent of the extent of hypertrophy.
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